Top Features of Revenue Cycle Management (RCM) Solution

November 4, 2022

Revenue cycle management is a multi-dimension process. If implicated correctly, hospitals and private practices can benefit from this system exponentially. RCM is a complex process balancing a practice’s revenues, patient flow, reimbursements and charges, ensuring the healthcare practice does not loose hard earned dollars through providing services.

Thus, hiring an external vendor for revenue management or purchasing an RCM solution is the only option. This article will guide you on the main features that one should review before selecting a RCM company.

Revenue Cycle Management (RCM)

Healthcare revenue cycle management (RCM) solution is optimized in a healthcare organization to balance incoming and outgoing cash flow, while keeping charge of every service payment. It overlooks the flow through:

  • Initial Patient Verification
  • Insurance Confirmation
  • Claim Submission
  • Denial Reduction
  • Medical Coding
  • Charting
  • Annual Financial Reporting
  • Errors Detection and Resolution

Revenue cycle management (RCM) uses multiple technologies to perform these functions, namely, artificial intelligence (AI), robotic process automation (RPA), and optical character recognition (OCR).

Obstacles In RCM Integration

Here are some challenges RCM integration might face:  

  • Compliance - companies may lose millions in fraud if their actions are not followed according to HIPAA, COVID, and HITECH laws.  
  • Interoperability of all past and current solution bases at the practice.
  • Education level of working staff and patients may impose hurdles.
  • Managing account receivables are sorted timely.
  • Billing errors and improper coding of healthcare services.
  • Shifting entire office system to digital is the key. Not doing so will pose hurdles in RCM integration.
  • Improper display of manual workflows might lead to incorrect placement of data by automated or technical staff
  • In order to shift data manual to digital, it is crucial that previously stored on-paper data is accurately placed.

Top Features of An RCM Solution

Every company delivers the best of their practices, taking use of multiple common features. Below are some key rising features that shall block revenue leaks of your practice in future:

Prior Authorizations

It is a human psychology that upfront cash claim after services taken, results in patient outburst. A recent study indicated that 40-60% of patients happily completed patient charges when informed of out-of-pocket cost initially.

Patient estimator technologies of an RCM solution creates a pattern for full transparency at both physician and patients end. Thus, helping patient to make much informed financial decision. This eases prior authorization protocol, aiding in reduced denials and higher satisfied patients later.

Data Capture Calculator

Studies show that average deductibles have topped up to 20,000 dollars over the years. Payment dynamics is shifted from payers to patients, indicating that patients are becoming the larger payers nowadays.

Patient liability is rising and patient’s understanding of this liability is not. This confusion is leading to uncompensated care, keeping physicians inaccurately paid for their delivered service. Another feature that highlights RCM solution and delivers higher patient experience, is calculating patient data capture accurately.

Once patients are communicated clearly of all the charges before service, chances of their relapse are low. Also, patient accountability will boost over time.

Practice Analysis Reports

Revenue cycle management encompasses several intricate steps of evaluation to deliver the right plan to fit your service. Annual and quarterly delivered analytics provide:

  • In-depth breakdown of revenue leaks and ineffective processes.
  • Reimbursement rates and claim efficiency comparison within the practice and alongside market competitors.
  • Identification of lost patient balances and uncollected charges.
  • Unpaid claims and reasons for claim denials.
  • Rejected claim percentage over the years.
  • Pro-active patient analysis.

Medical Coding Expertise

Every clinic is different in terms of specialty, care delivery, patient kind and technicality. Hence, one code style can never be subjected to all practices. RCM solution that delivers financial and medical experts keeping eye on changing codes, and following up with the medical coders shall resolve coding concerns. A perfect RCM solution effortlessly translate the treatments, medications, and disease conditions to targeted codes.

Opt for an RCM solution formulated with in-built code dictionaries. These are also effective and time-saving for physicians and revenue attractors for the practice.

CareCloud Concierge

Stay ahead of industry modifiers while enhancing your practice profitability with CareCloud Concierge

Our HIPAA-complaint solution is a cloud technology encompassed solution that stores, streamlines and evaluates patient data in a row. All, keeping the PHIs secured from technical espionage.

  • Timely collections of payments.
  • Daily pending payment reports.
  • Changing outcomes market analysis to modify with the health tech trends.
  • Simplified patient enrolment and credentialing with payer sources.
  • Accurate CPT and ICD-10 coding in relations to clinical and specialty specifics.
  • Seamless integration with other healthcare solution.
  • Automated flow charts and customizable charting.