Mastering the Basics of Healthcare Revenue Cycle Management

  • Written by Ashley Mark
  • Thursday 3rd August 2023
Mastering the Basics of Healthcare Revenue Cycle Management VLMS Healthcare

The healthcare industry is continuously evolving from fee-for-service to value-based care reimbursements. Therefore, it becomes critical for healthcare revenue cycle management to adjust accordingly. Healthcare facilities are known for treating patients with the best technology and saving lives. Healthcare organizations need robust strategies and policies to stay financially strong. This is where the role of the healthcare revenue cycle comes in. 

Healthcare revenue cycle management is a strategic financial process used by healthcare facilities to efficiently manage the administrative and clinical operations connected with payments, claims processing, and revenue generation. This process includes identification, management, and revenue collection through patient care. Healthcare revenue cycle management aims to ensure healthcare facilities' healthy operations with increased cash flow. Healthcare facilities utilize revenue cycle management to avoid missing profits and keep up with expenses. 

Basics of healthcare revenue cycle management

Healthcare revenue cycle management begins with the patient making an appointment to seek medical services and ends when the facility collects full payment and claims for the services rendered. Pre-registration here is crucial to optimize revenue cycle management. Employees should create a patient account that reflects their medical history and any insurance coverage. When the patient visit is done, the healthcare services provider must create a claim submission and should complete charge capture duties. 

Post-claim creation, the facility sends the claims to the government or private payer for full reimbursement. However, revenue cycle management is not limited to this only. The healthcare provider also needs to manage back-office tasks such as payment posting, claims reimbursement, payment collections, claims denial, and others. After the assessment of claims by the insurance company, healthcare providers receive the claims based on coverage and contract. 

The other scenario is that claims can be rejected for several reasons, including inaccurate medical coding, missing documents, and incomplete patient details. The healthcare provider must inform the patient and collect payment if insurance does not cover any treatment or procedure. Healthcare revenue cycle management develops strategies to help healthcare organizations get full payment for services quickly. 

How to stick with successful healthcare revenue cycle management

Healthcare organizations must be proactive and maintain profitability to notice the success of revenue cycle management. Organizations can plan and implement several strategies to increase the revenue cycle and collect timely payments. Simplifying patient access and front-end optimization is essential for successful revenue cycle management. Errors in front-end tasks such as registration, eligibility verification, and authorization are the top reasons responsible for claims denial. For this, outsourcing medical billing and coding to a medical coding company can be beneficial. Medical coding companies successfully manage all the processes to elevate the revenue cycle. 

Organizations can minimize the risks of claim denials by training staff for accurate coding and billing operations. Investing in digital technologies such as software to automate coding and insurance verification will help in successful revenue cycle management. Outsourcing revenue cycle management to a reliable partner is a great way to balance finances and patient care in economic crises. Furthermore, data analytics can also help in advanced care management and coordination. Healthcare facilities can also utilize data analytics to manage significant rates of healthcare information and forecast claim results by tracking the claim lifecycle. 

VLMS Global Healthcare is your reliable RCM partner

As a trusted RCM partner, VLMS Global Healthcare helps you accelerate cash flow through AR days improvement, eligibility verification, prior authorization, and other services that add value to your revenue cycle. Our RCM solutions will simplify your administrative tasks and ensure high reimbursement and service satisfaction.  

Discover how we can assist you