Thursday, August 17, 2017

Notes Concerning Revenue Cycle Management

By Andrew Cox


Revenue is a form of income gained from the sale of goods and or services or from various types of business transactions. This earnings does not necessarily entail cash received at hand but also receivables are part of revenue, cash expected to be paid at a future date. Revenue Cycle Management, RCM, is in this narrative, discussed in detail.

RCM, thereby, usually unifies the clinical alongside the business sides of healthcare, essentially by combining administrative information like the name of the patient, insurance provider, as well as any other personal data, with particularly the treatment that a patient receives, along with their entire healthcare information. RCM, therefore, is a very phenomenal component or advancement in the healthcare system.

This kind of cycle was introduced into healthcare to reduce the time between providing a medical service and receiving payment for the service during a patient care process. The cycle system allows both parties to analyze their data, enabling them to find out facts such as the number of patients exposed to a common type of illness. This is made possible by the use of cognitive computing, which ensures proper medical coding of claims and robotic process automation, which helps speed up the process by automating duties that would have previously been handled by employees.

The increased earnings depends mostly on how the physician manages time and practice workflow. A standard practice mostly commences when the patients is registered after evaluating insurance eligibility. Co-pays usually are collected and lastly the process ends with coding correctly the claims by use of ICD-10.

Firstly, RCM involves Charge capture, which essentially deals in rendering the medical services into billable fees. Claim submission is also involved in RCM, whereby billable fees claims are submitted to the insurance companies. Coding is also involved, and it entails properly coding procedures and diagnoses. Patient collections are also involved, and this basically entails the determination of patient balances as well as collecting payments. Other critical things involved in RCM are preregistration, registration, remittance processing, together with utilization review.

RCM is considered to be more than just a billing process. It a complex process that entails claim processing, revenue generation, billing and coding and patient payments. Coding is done on ICD-10 and only correct data is used. For RCM to be considered as successful it must have efficient billing system.

Outsourcing of RCM basically has its benefits and risks. Benefits include guaranteed profitability and efficiency since the income management staff are professionally skilled in their line of duty, reduced denied claims since the employed management staff are skilled in coding claims, the employed income sequence managing staff also ensure the healthcare system operations comply with the regulations set.

The income cycle system uses robotic process automation, and this saves up on time as compared to when an employee works on such tasks and the cognitive computing which ensures that coding of claims is done properly with zero to minimal error.




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