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The Essential Of A Successful Rcm Process

By Author: Prateek Shetty
Total Articles: 4

The Importance of a Good Approach to Healthcare RCM

Inefficiencies in RCM processes result in losses worth millions of dollars for healthcare practices in the United States every year. The fiercely competitive environment of the healthcare industry and the strict regulatory norms that hospitals and clinics need to adhere to, further magnify the problems resulting from RCM inefficiencies. There is however, a silver lining to this dark cloud of the ramifications of RCM inefficiencies. It exists in the form of possibilities and opportunities. There are measures that healthcare practices can adopt, to turn the tide in their favor and keep their revenue strong and well suited to match the demands of a value-based care reimbursement model.

From steps that can reduce errors in filing claims to follow up processes to create a case for payers to reimburse providers, there are so many things that you can do to improve the efficacy of your RCM process. The road to increasing the efficiency of your RCM process begins with identifying the essentials that can bring about a complete overhaul of your workflows. This rabbit hole goes deeper than you might think, but focusing on the basics will help you get off to a great start. The most logical approach is to focus on the essentials of a health and efficient RCM process.


The Essential Of A Successful RCM Process

A report by Mckinsey on US healthcare payments states that 15 cents of every US healthcare dollar go towards the management of RCM inefficiencies. This comes up to a staggering sum of close to $400 million in total across the United States. Healthcare practices are investing heavily on streamlining their RCM process flow and the following are their key areas of focus:

Technology: Robotic Process Automation, Machine Learning and Artificial Intelligence are three dominating technology trends that are advancing the possibility of process streamlining and quality enrichment in the RCM process of a medical practice. These technologies are quickly becoming the cornerstone of an efficient claims management, payment posting and accounts receivables management workflow. Core aspects of an efficient RCM process such as claims management, payment posting and AR management can benefit largely from automation and self-learning systems. They do this by identifying aging claims, reasons behind claims denials and by promoting patient eligibility checks. These systems can increase the turnaround times of claims filing and the fulfillment of outstanding claims by up to 30%.

Preventive Approaches: Key process points such as accurate payer enrollment and patient insurance benefits verification are vital preventive steps of a healthy RCM process. These steps will save you time that is otherwise spent on backtracking to the root cause of a denied claim. Reduction in the rates of claims denials and patient check-in times are two of the biggest benefits that you get from adopting a preventive approach to your RCM process.

Data Analytics: The capacity of data analytics to increase the visibility of financial and healthcare trends make it an essential component of healthcare RCM. Data analytics equips your healthcare practice with KPIs that give you insights on the root cause of denied claims and what can be done to mitigate its negative effects. It also doubles up as means that aids you in forecasting future business trends, leveraging business opportunities and improving the quality of your care delivery. Advanced iterations of data analytics such as healthcare BI (Business Intelligence) can also help you track the performance of healthcare professionals and claims management specialists which improves the overall potential of your profitability.


Dedicated AR Management: When healthcare practices allocate dedicated resources to the monitoring and tracking of outstanding payments, they get a bird's eye view of the entire process. A dedicated accounts receivables management team takes care of tracking aging claims that require immediate attention. Besides the obvious benefit such as handling overpayments and root cause analysis, a dedicated effort to AR management ensures that you are not in breach of any regulatory compliance requirements. The combination of faster collection times and compliance adherence makes it essential for a well-rounded healthcare RCM process.

Patient Education: Not many healthcare providers are willing to concede the effectiveness of patient education in streamlining their RCM process. But, training your staff to educate your patients goes a long way in avoiding bad debts once the treatment concludes. Provide your patients with estimates of the costs of care so they can receive their bill amount without being caught off guard. This concept of maintaining transparency in cost will increase the likelihood of you receiving prompt payments.

Every investment that you make to optimize your RCM cycle will fetch you sizable returns in just a matter of few months. A systemized RCM process is more than capable of increasing collections of revenue by close to 20%.

more info: https://nalashaahealth.com/revenue-cycle-management-billing-payers-whitepaper

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