So what’s RCM?

27 January 2021 - Ci Magazine
So what's RCM? Addressing denied claims and patient nonpayment can be a frustrating, time-consuming process. For this reason, many healthcare facilities are hiring Revenue Cycle Management (RCM) companies.

By Neale Pashley

Revenue Cycle Management (RCM) refers to a payment process that integrates an all-inclusive range of tools, practices, techniques and solutions that are closely interconnected to information and operational healthcare services. The goal of RCM is to ensure the healthcare provider or facility has a friction-free billing and payment process.

Neale Pashley VP, Partner Services

Neale Pashley VP, Partner Services

An RCM Strategy Should Benefit the Provider and Patient

A well-thought-out RCM strategy uses both preemptive and responsive methods to optimize the profits of healthcare facilities while providing each patient with improved healthcare services. In addition, the integration of healthcare providers, patients, insurance payers and billing companies while processing patient claims makes it possible for healthcare facilities to raise their revenue.

Reduce Payment Process Friction

When it comes to the payment process, friction refers to any issue that interrupts an otherwise smooth transaction. Examples of payment process friction include when a patient calls in to complain about his or her medical bill, or when insurance companies are denying submitted claims.

An insurance denial brings with it an array of questions:

  • Was all the information that was obtained from the patient correct?
  • Did the administrative team fail to verify the patient’s information?
  • Were the wrong CPT codes used?
  • Does the insurance need additional information? If so, what information is being requested?

Correct Patient Information is Vital for Friction-Free Payment Processes

To have a successful Revenue Cycle Management strategy, focusing on front-end tasks is key. Many of the medical billing errors that occur result from incorrect patient information. This incorrect information carries on throughout the revenue cycle, thus, disrupting claims reimbursement. Needless to say, when incorrect patient information is collected during the registration process, the payment process is interrupted. This delay in payment could cause the relationship between the patient and the provider to become strained. As a means to eliminate the frustrations associated with billing issues and payment processing, many healthcare facilities are choosing to hire an RCM company that can provide them with a solution for the issues related to claim denials due to missing patient information.

The Role of Technology in the Payment Process

Technology can be used to assess potential points of friction and then analyze that information to ascertain which issues are more likely to interrupt a healthcare facility’s payment process. Once this information is collected, healthcare facilities can use it to fine-tune their RCM.

Possible friction points include the likelihood of:

  • the health insurance company denying claims due to missing patient information.
  • the insurance company inappropriately denying claims.
  • claims being denied due to the use of incorrect CPT billing codes.
  • denials due to additional information requests.
  • denials due to inaccurate patient information.
  • a patient’s ability to pay his or her portion of the bill.

A good Revenue Cycle Management company can analyze this information for the healthcare facility and create a personalized plan to reduce the friction that is occurring in their payment process.

Changes in Healthcare Can Cause Payment Disruptions

The continuous changes within the healthcare industry can make it difficult to maintain financial stability, however, RCM companies stay abreast of these changes, thus, preventing any disruption to their clients’ payment processes.

4 Tips for Improving Patient Satisfaction and Front-End Tasks

As the healthcare industry continues trending toward consumer convenience, the importance of reducing friction must be recognized. Especially considering that patient satisfaction scores and value-based outcomes directly affect payments. Offering patients an easy way to pay and update their information can decrease friction and increase revenue.

1- Offer Individualized Platforms

Allowing patients to pay their bills online makes the payment process easier, which is likely to increase patient payments.

2- Provide Patient Portals

A patient portal provides a way for patients to update their insurance information and set up payment plans for any outstanding medical bills. Providing patients with a platform they prefer will increase the likelihood that the patient will settle his or her account.

3- Verify Patient Information

Technology can be used to reduce the number of insurance denials that occur due to incomplete or inaccurate information. This verification process is possible because the patient’s information on a claim can be compared to his or her policy information. This allows the medical biller to ensure there are no discrepancies that could delay payment.

4- Verify Patient Eligibility

Checking a patient’s eligibility as well as verifying that a statement is correct before sending it to the patient also reduces friction.

Technology can reduce the incidence of many issues that are responsible for impeding the payment process. Healthcare facilities that neglect to prioritize their clientele will fall behind, leaving the door open for their competitors. Especially since patient satisfaction serves as the main component in today’s value-based era.

Choosing a Revenue Cycle Management Company:

To choose the RCM company that will meet all your needs, there are several questions that need to be answered.

Questions for a Revenue Cycle Management Company

  • What is the strategy for identifying, validating and solving patient registration issues and missing claim information?
  • How do you ensure correct coding and how is coding accuracy audited?
  • What is the source of truth for auditing billed charges and what is the process for ensuring all charges are billed and paid appropriately and per contract with each payer?
  • How do you optimize denial management?
  • How are Worker’s compensation claims handled differently?
  • How are governmental payers handled differently?
  • What are the unique needs of Medicaid in my state?
  • How do revenue cycle strategies differ for 3rd party liability, Ideal provider organizations, Better managed care, Guaranteed insurers?
  • Do you perform automatic write-offs, if so, why?
  • Is every unpaid claim viewed at least once by an experienced denial management representative?
  • What access is given to data and reporting to ensure transparency and evidencing success?
  • How do you maximize patient collections, patient satisfaction and manage the patient’s perception of the medical group?
  • How does your technology enhance human interactions in the billing process?

A reputable RCM company takes care of all these issues and more, thus, reducing the stress on the healthcare professional by keeping the payment process moving along smoothly.