Healthcare Revenue Cycle

Revenue cycle management or RCM solutions for healthcare providers are software platforms for carrying out activities associated with billing and payments at medical organizations. RCM software for providers includes features to handle medical coding, claims, and payment processing. It is integrated with other health platforms like electronic health records and practice management solutions to enable an organization to streamline all operations surrounding revenues. Software solutions for health revenue cycle management allow providers to consolidate all the billing activities for services right from appointment to discharge and final payment.   

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This is one of the first things that happens on the providers’ side when a patient walks into a clinic or hospital. The staff verifies if the patient’s health plan can cover the services that would be prescribed and to what extent. OSP can build a platform for revenue cycle management for healthcare providers with a feature to verify insurance plans rapidly. This will clearly show the amount provided as coverage and the amount paid as out-of-pocket charges by the patients.   

This application for provider revenue cycle management reduces wait times for patients and eliminates the possibility of verification errors. Manual verification might lead to mistakes that deny providers reimbursement, unlike a software solution that leverages healthcare automation  

Sending claims to payers is how providers earn reimbursements, which form the major portion of revenues. But it is common for errors in claims, which result in denials or rejections by the insurance company. In light of this, OSP can design and develop a healthcare revenue cycle management platform that checks each claim before it’s sent to payers. This solution would assess the claims and highlight points where there might be discrepancies, which can later be checked manually by staffers. Claim errors are among the biggest reasons for the loss of reimbursements for providers. But our solution can minimize errors and ensure that all the claims sent comply with payers’ policies.  

Denial of reimbursements can cost both time and revenue for providers. There can be numerous reasons why insurance claims get denied, after which providers have to follow cumbersome processes to handle them. But OSP can build HIPAA-compliant solutions for managing the healthcare revenue cycle, which can assess denied claims rapidly. This feature would harness healthcare analytics solutions for identifying patterns among denied claims. By knowing the problems that cause payers to deny claims, providers can address them for future prevention.  

Whether it is the revenue cycle of a healthcare practice or a hospital, our solution will help streamline the workflows around claims submissions. In other words, it will boost the efficiency of provider revenue cycle management.  

The revenue cycle in healthcare is composed of reimbursements as well as out-of-pocket payments, among others. OSP can build RCM software for providers to have detailed reports on the status and composition of their revenue cycles. In other words, this platform will offer a comprehensive dashboard that administrators can use to view everything related to revenues, like accounts receivables, reimbursements, out-of-pocket payments, and so forth. It would also help determine which payers reimburse the fastest, deny the most, etc.   

These insights will help in taking measures to address inefficiencies in medical billing and revenue cycle management. Healthcare interoperability and seamless electronic data exchange amongst all the medical solutions ensures that the reports reflect accurate operational data.  

A cloud-hosted software solution prevents it from being installed on computers kept on-premises and also avoids the need for a dedicated IT infrastructure. OSP is a leading revenue cycle management software provider that can help healthcare organizations adopt cloud computing in healthcare. We can build a cloud-based revenue cycle management solution that can be accessed from any computer through the internet. This will be especially helpful for small practices and clinics since they won’t have to spend on dedicated hardware.  

Cloud availability makes it an ideal choice for use with integrated healthcare solutions since multiple providers would collaborate across the care continuum. Furthermore, using custom medical informatics solutions to find patterns in claims and reimbursements would also shed light on the efficiency of healthcare management 

Medical coding converts medical diagnoses, procedures, and services into an established set of standard alphanumeric codes. It indicates all the billable services rendered to the patients, which are sent to payers in the forms as claims. OSP can design and build provider revenue cycle management software with features for automated medical coding. This will accelerate all the workflows surrounding coding and ensure that there are no errors.   

Coding mistakes account for a large portion of denied and rejected claims. Since our solution minimizes human intervention, it will minimize denials and rejections. As a result, it becomes an excellent tool for optimizing healthcare revenue cycle management.

Benefits 

Software for healthcare provider revenue cycle management helps to consolidate all the billing and revenue workflows into one interface. As a result, all pen and paper-based activities are digitized, making them faster and more accurate. This means that a relatively smaller staff can do more with little to no errors. So, practices, clinics, and hospitals can experience greater productivity with fewer resources, reducing overhead. 

Mistakes in coding and claims are the most common reasons for denials and rejections by payers. But the provider revenue cycle management that OSP can build would digitize and automate large parts of the workflows around coding and claims. As a result, there are very few errors, which directly lead to few denials. Moreover, the few denials that may still happen can be analyzed using this software to address problems.

Verifying claims and getting pre-authorizations can result in long wait times for patients. Not only is this an inconvenience, but it also affects patients’ health in case of the ones who need urgent procedures. But software for healthcare revenue cycle management reduces these wait times by accelerating pre-approvals and insurance verifications. This goes a long way in improving the experience for patients. 

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