Healthcare is often expensive, largely because it’s costly to provide. From facility fees, to equipment costs, to everyday overhead expenses, to personnel wages—the costs associated with running a healthcare organization are high. Medical practices deserve to be compensated for the critical services they provide, but it’s challenging to juggle collecting payment from patients, insurance providers, and other payers.
Revenue cycle management, or RCM, is a common set of processes billing staff follow to track and collect revenue from clients. The goal of RCM is to ensure professionals across many industries are paid for their services as quickly as possible.
What is revenue cycle management in healthcare?
RCM isn’t tied exclusively to healthcare, but it plays a vital role in ensuring medical professionals are fairly compensated for their work. Revenue cycle management in healthcare involves managing claims, bill payments, medical billing collections, and revenue generation for patient services.
The healthcare revenue cycle starts with patient onboarding and ends when the services provided have been paid for. A clearly defined RCM process will continuously improve a practice’s revenue, allowing providers and their staff to ultimately spend more resources on patient care.
Effective revenue cycle management strategies may also reduce patient bills by preventing billing errors and inefficiencies.
The RCM process includes four key steps:
- Patient Charge Capture: Capturing demographic, contact, and charge information for patient billing purposes.
- Coding and Claim Submission: Medical services are associated with a variety of billing codes to help standardize service costs across providers and minimize the chances of a claim denial. These claims are then sent to insurers for payment.
- Insurance Follow-Up and Denial Management: Practices liaise with insurance providers regularly to collect payments and follow-up on patient coverage eligibility. Denied claims are reviewed by the provider, who may be able to correct and resubmit a claim.
- Payment: Sometimes, insurance covers a portion of the bill, and the rest is sent to the patient. RCM systems help streamline this process and also allow patients to understand what they are being billed for.
Who typically handles medical RCM?
The responsibility of revenue cycle management doesn’t always fall on dedicated medical billing staff. Many practices can’t afford to support that resource internally. For most small to mid-sized medical practices, billing services is another function tacked onto already existing roles.
The front-office staff that handles medical billing are splitting time between patient management and practice management. This can lead to data entry errors, rejected medical insurance claims, or poor patient experience.
Healthcare providers servicing their own medical billing might leave money on the table while trying to serve patients, handle admin work, and other duties. Providers may have experience with medical billing, but could better spend their time on serving patients to maintain/increase patient satisfaction and revenue.
Medical Coders and Medical Billers both functionally operate within medical billing, but acquiring talent comes with two caveats: they are often difficult to source due to high-demand job markets and are expensive to source for small to mid-sized practices.
The search for an RCM solution begins when the overwhelming pains of medical billing become too much for office staff and health care providers to handle.
How outsourcing RCM with Benchmark Solutions saves your practice time and money
Outsourcing medical billing and RCM has numerous benefits.
- Outsourcing medical billing, contrary to popular belief, saves your practice money. Benchmark RCM brings dedicated and experienced medical billing experts at a fraction of the cost of a full medical billing staff.
- Errors in medical coding are costly and easy to make. They result in claims denials and delayed accounts receivable. Dedicated billing experts, like the ones at Benchmark Solutions, have experience navigating the complex world of medical billing, which leads to fewer initial errors.
- Clients using Benchmark RCM benefit from seamless integrations with their practice management software and electronic health records. Healthcare organizations are also pressed to comply with value-based care models, versus fee-based models. That means the providers must report on more metrics of quality care, including patient satisfaction, in order to receive insurance reimbursements. Our team is familiar with navigating PM and EHR software–and we even offer our versions of these platforms for maximum cohesion.
- Benchmark RCM clients also benefit from no upfront fees. We get paid when our clients receive successful transactions, allowing medical practices to control their cash flow.
With Benchmark RCM, clients reduce their AR to an average of under 30 days and minimize errors, resulting in a 98% clean claims rate.
Benchmark RCM specialists are experienced and dedicated revenue cycle management experts with a proven process and track record. Our team can handle account and denial management, data entry, reviewing codes, and minimizing errors, so medical practices get paid faster and improve overall profitability.
Learn how Benchmark Solutions RCM can save your practice time and money.