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.
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.
We’ve reached out and found companies like OSP to create our technology. This is my first time working with a company that has been so thorough. These guys are amazing. If you really are looking for someone for a technology solution, these guys are the real deal.-- Stephen Carter
We reached out to OSP to provide an estimate on a technology solution we were interested in developing. From the initial conversation, the team was professional, courteous, and thorough. We were able to make a quick decision to move forward with OSP because we were confident that our requirements were accurately captured and the development deliverables and associated costs were clear.
The OSP development team stayed on schedule and within budget throughout the build phase and provided weekly communications to keep our team informed along the way. If we require application development in the future, OSP will be the first call we make.-- Selita Jansen
We have worked closely with OSP for two years, meeting twice a week to work through development requirements, strategy, design, progress, and support. OSP has become an integral part of our business, and our mutual teams work together as one team. OSP tackles problems that arise with integrity and operate with respect for budgeting.-- Charlie Langdon
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Revenue cycle management (RCM) is all the activities in tracking the entire series of processes involved in patient care. It helps providers to bill for their services appropriately and earn revenues.
RCM allows providers to identify problems in their revenue streams and fix them, allowing for steady income streams. This allows them to keep serving patients efficiently.
Medical billing is a highly complex process. It begins with patient registration and progresses with eligibility verification, coding, charge capture, and claims submissions. A good provider revenue cycle management solution streamlines all the activities mentioned above with digitization. Such software solutions also automate many activities involved in the RCM process. This minimizes or eliminates human errors and accelerates the whole process, resulting in higher productivity and greater revenues.
This is the first step in the entire lifecycle of medical RCM. It involves collecting patients’ demographic insurance information.
This step ensures that the patient’s insurance coverage before offering medical services. It is crucial for avoiding claim denials
A claim includes all the medical services coded per established standards to be submitted to payers for reimbursements.
Claims might be denied for any number of reasons. Denial management handles denials and also ensures that it never happens again.
This is the process of collecting payments from patients and insurance payers.
Technology solutions for provider revenue cycle process digitize the whole lifecycle of RCM. Moreover, automation eliminates the need for human operators to carry out manual, repetitive activities. As a result, these tasks are accelerated and immune to human errors. Automation eliminates or minimizes the chances of mistakes and also speeds up processes significantly.
With or without automation, software for revenue cycle management (RCM) provides one interface for all activities. The staff need not enter the necessary data manually since the solution lets them fetch it and enter it with some clicks. This is how the software streamlines the entire RCM process.
Automation using artificial intelligence and machine learning are the hottest trends in healthcare, especially RCM. These technologies automate repetitive manual, rules-based processes. Doing so frees up time for the staff to do other things and lowers overhead. Lower overhead and increased speed maximize productivity.
This is a major topic of deliberation among clinicians and policymakers for healthcare. It aims to lower the costs of care by prioritizing outcomes for patients.
This approach to RCM focuses mainly on the patients rather than the providers or payers.
Data Analytics-Driven Operations
Business intelligence garnered from data analytics provides insights about reasons for claim denials, payment delays, reimbursements, etc. This allows hospitals to make informed decisions about relevant workflows.
Electronic health records contain all patients’ medical, demographic, and insurance information. By integrating an EHR with an RCM platform, the data entry and documentation part of the process is streamlined. Things like pre-authorization are done rapidly and automatically with an EHR. Since pre-authorization errors account for roughly a quarter of all claim denials, EHR integration optimizes the whole RCM process.
In addition to fast pre-authorization, things like coding and claims processes are also fast and mostly automatic. This is because the necessary data is obtained from health records with a few clicks and used for the relevant RCM activities. This proves that EHR implementation and integration with RCM solutions boost overall revenues.
The processes around revenues in healthcare are complicated by nature. There are too many steps that open up too many chances of errors. Starting from verifying patients’ health plans to charge capture, coding, and claims generation, coupled with denial management. So, errors or inefficiencies in any one step translate into lost revenues. This is where provider revenue cycle management solutions become necessary.
Provider revenue cycle management solutions streamline all the activities in the RCM lifecycle. Moreover, these software platforms also automate many processes, increasing their speed and minimizing human errors. As a result, individual providers at private practices and even hospitals can have a highly optimized revenue cycle with significantly lower overhead.
The results of a good revenue cycle management process include fewer claim denials, faster insurance verification, rapid and error-free coding, better denial management, and so on. All of these only result in higher revenues for healthcare organizations.