What is Revenue Cycle Management and Why Is It Important?

The Healthcare Financial Management Association (HFMA) defines revenue cycle management (RCM) as “all administrative and clinical functions that contribute to the capture, management and collection of patient service revenue.”  In other words, it is a term that includes the entire life cycle of a patient account from creation to payment. It is the lifeblood of your practice.

In today’s healthcare environment, physicians and healthcare providers must focus more on the business side of their practice to ensure long term sustainability. Many practices have gone bankrupt because of increasing claim denial rates. It is estimated that US physicians face a loss of at least $125 billion every year because of poor medical billing and little to no revenue cycle management.

Did you know that CMS rejects nearly 26% of all claims and up to 40% of those claims are never researched, corrected and resubmitted? This can result in lost revenue of up to 10% of your collections. However, with the proper revenue cycle processes and workflows in place, your office can increase reimbursements, maximize cash flow and decrease bad debt write-offs.

Onpoint specializes in Revenue Cycle Management or RCM. We know that RCM starts with staff training, workflow assessment and communication. Optimizing your revenue cycle requires a complete analysis of all processes. If one person isn’t doing their job correctly, completely or consistently, it will affect the outcome of the entire team. In most cases, errors are the result of inadequate training and the lack of understanding about how one person’s job affects the entire outcome. The RCM solution doesn’t end with training and education. It continues when a patient schedules an appointment and your staff captures and verifies the patient demographic information e.g. patient’s name, responsible party, phone number, address and the name of their current insurance company. It continues by automating business processes leading to speedy follow ups, which encompasses patient and payer follow-ups. The cycle ends when the balance on their account is zero. Healthcare providers need to maintain a faster RCM cycle to stay solvent, maintain requisite cash flow, and keep revenue figures stable.

Reports and related analytics are many times overlooked or left to the practice to generate. However, Onpoint believes that reports and analysis are tools necessary for success. As part of Onpoint’s RCM services, reports, both standard and customized, are provided at no extra cost to the practice. These reports detail both charge and payment trends, encounter trends, denial information, and report on charges that have not been submitted thus guaranteeing no missed revenue. Regular reporting with analytics allows the provider to effectively forecast the continued growth and profit of the practice.

For some practices, the responsibilities of the revenue cycle can become overwhelming and conflict with other office duties (managing employees, keeping up with government programs like Meaningful Use and PQRS or other administrative tasks). However, that shouldn’t keep your office from becoming financially efficient. If you are interested in optimizing your revenue cycle, consider a Revenue Cycle Management company that will partner with you to get the most out of your office’s revenue cycle. Don’t wait — every day without the correct processes in place can result in decreased revenue for your office.

Onpoint Medical Solutions has all of the bases covered when it comes to revenue cycle management. Some billing companies charge for RCM, as if it is an additional service that you can do without, but at Onpoint there is no extra charge for providing you with complete, accurate and timely billing, collection and RCM services. It is what we do. It is what you deserve.

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