RCM is an integral part of the healthcare industry. Revenue cycle management involves all processes aimed at improving and optimizing revenue generation. The primary payers for most healthcare practices are the insurance providers. The crucial task of a revenue cycle management company is to know how each payer functions and create claims that pass through smoothly and generate cash flow and revenue to the service provider.

Here are the top features of any great healthcare revenue cycle management company. These features remain the same despite the location of the company and the length and breadth of services offered.

1. Getting the basics right

What are the basics when it comes to healthcare RCM? For any claim to be reimbursed, the payers expect it to be accompanied by the right documentation and include only services that the patient is eligible to receive. If these two processes are done right, a large number of denials can be prevented.

A well-experienced revenue cycle management company understands the importance of documentation and employs experts who get this right. There are two processes related to patient eligibility. When a patient calls in for an appointment, the RCM team needs to ensure the patient is eligible to receive the service in advance. It should also check if some of the services required need prior authorization and get that in place before the appointment. Doing this not only makes claims go through easily but also improves patient experience.

Identifying existing problems and offering corrective solutions

All healthcare practices will have a certain revenue cycle process in place. When they hire an expert revenue cycle management company, the first thing the company should do is look at the existing process and identify potential problem areas. They must have a period of analysis before taking over.

Identifying and eliminating root cause problems will pave the way for better processes to be adopted by the health practice. This is an important feature of a good RCM company – taking time to identify issues and resolve them without jumping in right away.

Expert denials management

The industry average for denials is about 10%. However, some healthcare practices may face denial rates of up to 40%. Identifying the current denials rate and working on bringing them down is one of the important features of a good revenue cycle management company.

This isn’t a straightforward approach, though. The team will need to put extreme effort and skill into getting the rate down. The expertise of the team clearly shows up in the way they handle denials.

Technological support

Healthcare practices don’t find it logical to invest in expensive technology that doesn’t support their core competency – treating patients. That’s why a revenue cycle management company must come with all the technological expertise needed to make RCM a breeze for their clients.

This involves choosing the right tools and solutions, staying updated on what’s new in the industry, and upgrading tools regularly.

Takeaways

A revenue cycle management company needs to take over revenue management for its clients. This will include touching and making changes to every single process in the system and being more of a partner than a service provider. Take time in choosing the right partner for your needs as they can completely transform the way you generate revenues.