8 Steps Of Healthcare RCM And How To Improve Them For More Profits?

Revenue cycle management for healthcare providers is the process that starts with a patient scheduling an appointment and ends with the payment of services rendered. This cycle includes several steps that are crucial for the financial stability of healthcare providers. In this article, we will discuss the steps of the revenue cycle for healthcare providers and tips to improve each step.

Revenue Cycle Management |Step 1: Pre-Registration 

This is the first step of the revenue cycle, where the healthcare provider collects demographic and insurance information from the patient. This information is essential for the provider to verify the eligibility and benefits of the patient’s insurance.

Tips To Improve:

  • Adopt an online pre-registration process to reduce waiting times and improve accuracy.
  • Train staff on how to verify insurance benefits accurately to avoid claim denials.

Revenue Cycle Management |Step 2: Registration 

The next step is where the provider confirms the pre-registration information upon the patient’s arrival for their appointment. At this stage, they also collect additional clinical information related to the patient’s medical history and the reason for the visit.

Tips To Improve:

  • Use electronic health records (EHRs) to capture accurate clinical information and reduce paperwork errors.
  • Train staff to collect the necessary information accurately and efficiently to minimize wait times.

Revenue Cycle Management |Step 3: Charge Capture 

Charge capture is the process where the healthcare provider records the services provided to the patient and generates charges for those services.

Tips To Improve:

  • Implement an automated charge capture system to reduce errors and improve accuracy.
  • Train staff on proper coding and documentation to ensure that services are billed correctly.

Revenue Cycle Management |Step 4: Coding 

Coding is the process of assigning numeric codes to the services provided to the patient. These codes are used for billing and reimbursement purposes.

Tips To Improve:

  • Provide ongoing coding education to staff to ensure that codes are assigned correctly and up to date.
  • Utilize technology to streamline the coding process and reduce the potential for errors.

Revenue Cycle Management |Step 5: Claim Submission 

After coding, the provider submits the claim to the patient’s insurance company for payment.

Tips To Improve:

  • Have an effective system in place to verify all the necessary information is included in the claim to avoid claim denials.
  • Automate the claim submission process to reduce errors and save time.

Revenue Cycle Management |Step 6: Payment Posting 

Payment posting is the process where the provider receives payment from the insurance company and records it in the patient’s account.

Tips To Improve:

  • Use electronic payment posting to improve accuracy and reduce processing time.
  • Implement an automated payment posting system to reduce manual errors.

Revenue Cycle Management |Step 7: Accounts Receivable Follow-up 

After payment posting, the provider follows up with the insurance company to ensure that the claim was processed correctly and to address any denials or underpayments.

Tips To Improve:

  • Use technology to automate the follow-up process and reduce manual errors.
  • Have an effective system for tracking and resolving outstanding accounts receivable to ensure timely payment.

Revenue Cycle Management |Step 8: Patient Collections 

Patient collections are the process of collecting any outstanding balances from the patient after insurance has paid their portion.

Tips To Improve:

  • Provide clear communication with patients about their financial responsibility before and after services are rendered.
  • Develop and implement a payment plan system to assist patients who cannot pay their balance in full.

Revenue cycle management for healthcare providers is a critical process for financial stability. By implementing these tips to improve each step, healthcare providers like you can reduce errors, increase efficiency, and ensure timely payment for services rendered.

But when you want to improve the whole process at once, the best option is to hire an RCM outsourcing partner who will implements the best processes and practices to streamline the process for good. Lucky for you, that’s what we specialize in. You can learn more about our RCM services here. 

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