Revenue Cycle Management For Hospitals

Revenue cycle management (RCM) consists of all the processes healthcare organizations use to bill for patient services. It begins with patient registration, charge capture, claims submission, remittance processing, follow-ups, and patient collections. Revenue cycle management solutions for healthcare enable hospitals and clinics to streamline and optimize all the workflows surrounding revenues and improve incomes. Companies involved in software product development can analyze a hospital’s processes and design RCM software to accelerate and automate activities. This minimizes the chances of errors and, in doing so, reduces the possibility of rejections and denials.  

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This can be called the first step toward revenue cycle management in healthcare. It determines the extent of coverage provided by health plans and the number of money patients will need to pay upfront. OSP can design and build custom healthcare software solutions for insurance verification. Using this, staffers at medical centers can rapidly determine if a patient is eligible for certain care services and how much the health plan would cover. This process will take a minute or two and reduce patient wait times.   

A software solution would do this faster and more accurately, preventing the need for staffers to do it manually. Additionally, since it is largely automated, there are bound to be fewer mistakes that might result in denial later.    

This is one of the initial steps involved in the entire revenue cycle management process at healthcare organizations. Pre-authorization is when an insurance payer company decides if a certain prescription, treatment, service, procedure, or medical equipment is necessary. Patient pre-authorization is waived off only in case of emergencies. OSP can develop revenue cycle management solutions with pre-authorization modules to reduce manual work, prevent redundancy, and shorten the overall period of pre-authorization.   

This goes a long way in reducing wait times for patients who need important treatments and enables providers to focus their efforts better. When used in cohesion with patient engagement systems, a hospital can notify patients immediately of authorizations.  

Medical coding is translating clinical visits into a set of established medical codes. This is done to maintain medical records and fill out claims detailing the services provided by the hospital or clinic. OSP can develop automated healthcare solutions for hospital revenue cycle management, including a medical coding function. Since it largely automates the process, our solution can carry out coding faster and more accurately. Since automation limits human intervention, there are fewer errors.  

Coding errors are among the main reasons for rejections and denials of claims. Elimination of errors boosts revenue cycles for providers. Integration with practice management solutions will enable small practices to streamline RCM workflows.  

There are many reasons for the denial and rejection of claims. Different payer companies would have differing conditions, and if claims don’t match those, it could result in partial reimbursement or denials. OSP can develop hospital revenue cycle management solutions with a function to assess claims before they are sent to payers. This highlights any irregularities or errors in the claims, allowing the medical staff to make corrections. Claims analytics is one of the most effective tools to prevent denials and improve the efficiency of hospital revenue cycle management.   

Integration with existing medical systems and rapid electronic data exchange enables large hospitals to leverage the benefits of claims analytics. This would go a long way in boosting revenues and improving overall efficiency.  

One of the important underlying aspects of hospital revenue cycle management is the ability to track patients’ medical information across the care journey. This includes diagnoses, test results, scans, prescriptions, clinical interactions, etc. This provides the basis for filling out and submitting claims to payers and tracking the same. OSP can include healthcare management functions within the custom revenue cycle management solutions that we would develop.   

This will enable the non-clinical staff at medical centers to capture all the healthcare data throughout the care process for patients. Furthermore, this would also be beneficial where integrated healthcare solutions are in use and multiple physicians coordinate treatments.  

Denial of claims is one of the most common reasons for a reduction in provider revenues. There can be a broad range of reasons for claims getting denied. However, an analysis of denials over some time sheds light on why they happened. OSP can build a tailored hospital revenue cycle management platform with a feature for denial management incorporated within. This will assess all the denied claims and provide insights into recurring patterns.  

Providers and other staff would know which part of their workflow needs correction and can go about implementing changes. Knowing the reasons for denials for each payer is an important aspect of revenue cycle management operations. The presence of medical informatics can also boost the efficacy of denial management operations.

Benefits 

Revenue improvement is the biggest and most visible advantage of using hospital revenue cycle management solutions. These solutions help increase the profits for all healthcare organizations, from large hospitals to small single-physician clinics. By streamlining all the activities involved in RCM, these solutions also lower the overhead. In other words, reduced overhead and fewer denials result in higher incomes for providers.

Waiting to know if they are eligible or if their health plans would authorize services is a major inconvenience for patients. But by reducing the wait times involved in these processes, hospital revenue cycle management software solutions reduce patient anxiety significantly. This is especially true for people who might need to undergo extensive surgery or need specialized equipment. In other words, RCM software directly affects the overall patient experience.

Mounting accounts receivables (A/R) lead to increasing losses for providers. This can be especially difficult for small to medium clinics. But a software solution for revenue cycle management in healthcare enables medical organizations to manage A/R. In other words, they can ensure timely payments for services rendered. This is especially helpful for providers using advanced telehealth solutions to provide remote care services.

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