By Richa Jain, Digital Marketing Manager, PCH Health (an Exela Company)
LinkedIn: Richa Jain
LinkedIn: PCH Health
Today, there isn’t a single place where you cannot read about how technology is transforming the healthcare industry; technology is mainstream- it’s everywhere. Now, cloud-based electronic health records (EHRs) have taken over the walls of paper records that used to dominate physicians’ offices. 3D printers are creating magic for surgical planning and custom implants. Extended reality (XR), the mix of virtual reality(VR), mixed reality(MR), and augmented reality(AR), holds the potential to be the next significant computing platform. Moreover, robots today are assisting physical therapists and surgeons.
While it is clear that technology is opening new horizons for medical practices, we can’t ignore the fact that healthcare RCM is one sprawling operation; it encompasses processes starting from patient registration to collections and needs a tech overhaul.
Let’s explore how we can leverage technology to enhance revenue cycle management.
What is revenue cycle management?
Revenue cycle management is the process that handles the collection of payments for healthcare services and the management of claims. It plays a vital role in healthcare providers’ financial operations. From the moment a patient enters a healthcare facility—whether a hospital, clinic, or private practice—RCM involves a series of administrative tasks that ensure providers are accurately compensated for their services. At its heart, RCM ensures healthcare providers receive the payments they deserve by managing patient interactions and navigating the often intricate insurance processes.
How can technology help optimize revenue cycle management?
Technology is crucial in optimizing RCM, enabling healthcare organizations to streamline and improve their financial operations. Integrating technology with RCM brings real-time efficiency and connectivity, transforming how healthcare providers handle their revenue processes.
Modern RCM relies on various technologies, from simple tools like Excel spreadsheets to advanced solutions like enterprise content management (ECM) and business process management software. These technologies form a cohesive system that connects different parts of the revenue cycle, ensuring efficient and accurate data management.
The complexity of RCM is evident in its many tasks. Technology is essential at every step, from verifying patient identities and checking insurance eligibility to collecting co-pays and coding charges accurately.
Coding, in particular, is a critical and complex part of the process, requiring significant investment in technology and staff training. This complexity can be challenging for healthcare providers, especially those with limited financial resources. The speed and efficiency with which a healthcare organization can collect revenue directly impact its overall performance and growth potential. IT-based solutions, such as EHR software, are vital in accelerating the revenue cycle, ensuring a consistent flow of funds necessary for maintaining operations and supporting organizational expansion.
Commonly used RCM technologies
Here are some of the most common revenue cycle management technologies providers generally use to optimize operations.
Practice management systems
A PMS, or practice management system, supports a medical practice’s billing and administrative tasks. According to the AMA (American Medical Association), these tasks incorporate scheduling appointments, capturing patient demographics, pre registering patients, benefit verification, maintaining a payer list, billing, and so on.
Patient accounting systems
Patient accounting systems control the financial aspects of patient care, from invoicing, billing, and claims management to patient statements and payment processing. A PAS is different from a PMS as it is more aligned with RCM goals and focuses solely on individual patients to generate bills and claims.
Claims management and clearinghouses
Claims management solutions refer to the tools that enable providers to manage and submit claims to payers.
The software automates claims workflows right from the claim creation to final payment. Moreover, the software typically supports status tracking, denial management, claims adjudication, reporting, and analytics. Providers can leverage this tech tool to maximize the clean claims rate and reduce claims denials or delays.
Patient eligibility verification solutions
Providers can use these solutions to verify patients’ insurance eligibility and coverage for medical services. Such solutions leverage state-of-the-art technology to deliver real-time coverage status verification.
Revenue cycle analytics
Analytics tools use business intelligence to tap into financial data and determine revenue cycle efficiency and performance. Such solutions analyze data related to claims, collections, billing, and reimbursement to identify areas for improvement and new trends.
Conclusion
Leveraging modern technology to enhance revenue cycle management is necessary in healthcare today. By integrating state-of-the-art tools and software, healthcare providers can streamline processes, accelerate revenue collection, and reduce errors. Get on this new endeavor where technology meets innovation to transform lives.