Healthcare revenue cycle management is a complex set of administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue. It is an extremely important function that helps medical facilities ensure that they are paid for the services they provide to patients.
Revenue cycle management systems are designed to streamline critical front-end tasks such as ensuring that patient insurance eligibility has been verified, that accurate demographic data has been collected and that referrals or authorizations have been obtained for the procedure in question. This allows medical facilities to reduce the number of claim denials and rejections, speeding up compensation while improving the patient experience. These healthcare revenue cycle management tools also make it easier to transition to value-based care models that shift from fee-for-service reimbursement to pay-for-performance contracts.
According to Coherent Market Insights, Integrated solutions is likely to be the primary growth segment in the Healthcare Revenue Cycle Management Market owing to improved operational competencies and smooth economic and clinical structure with better management of treatments, outcomes, and most importantly, costs related to these treatments. The healthcare revenue cycle management market plays a vital role in streamlining financial processes for healthcare providers. With the complexities of billing, coding, and claims processing, RCM solutions have become crucial in maximizing revenue and reducing administrative burdens. As healthcare systems seek to enhance efficiency and reduce costs, the demand for advanced RCM technologies is on the rise. Embracing these solutions can lead to better financial outcomes and improved patient care.
The back end of the healthcare revenue cycle is responsible for submitting claims to payers, processing payments, and following up with third parties to collect outstanding balances. It is a highly specialized work stream that requires detail-oriented, reliable, and persistent team members. It is also a very busy work stream that often faces significant challenges. Some of these challenges include dealing with claims that are rejected or underpaid, as well as analyzing the reasons for a claim denial and following up with the payer or patient telephonically to resolve the issue.
Another key function of the back end is to make sure that all services rendered by a medical practice are accounted for and documented in the correct code, as well as making sure that those charges are then submitted to the proper payer. It’s a crucial process that’s difficult to get wrong, whereas one that can still have significant ramifications for a healthcare organization if it is. The global Real World Data (RWD) Market size is projected to grow from US$ 1.59 billion in 2023 to US$ 4.07 billion by 2030, at a CAGR of 14.5%.
An experienced advisor can audit the charge capture process to make sure that all fees are accounted for and that the proper codes have been assigned to each visit. An audit can also uncover missing charges and identify miscoded services that need to be corrected. Without efficient healthcare revenue cycle management, a medical practice could face numerous issues including delayed reimbursements, financial instability, and legal repercussions. An experienced advisor can also make sure that all routine statements are sent out on time and that they are mailed to the right patient accounts with the correct information. This can save a medical practice significant amounts of money by preventing bad debt from accruing and encouraging patients to pay their outstanding balances.
R1 RCM, Inc. and Rush University System for Health, entered in a strategic partnership in January 2020, for augmenting innovation and achieving a revenue cycle performance excellence in healthcare.