Revenue cycle management, better known as RCM, is a business process that allows healthcare companies to be paid for providing services. For most healthcare service providers, RCM is available right from the process of pre-registering a patient all the way through the collection of final payment. Efficiency and time management play vital roles in RCM. A healthcare provider’s choice of electronic health record (EHR) can often be largely centered on how its RCM is deployed.
The implementation of RCM in a particular healthcare company is a lengthy process. The company has to submit all the documents of its patient to the in-house staff or RCM vendor, who will then code the charts according to the ICD-10 CM. Afterward, the claims are posted, submitted, and adjudicated by the payer. If a claim is rejected, steps are taken to resubmit and adjust it before the deadline of appeal. Then the patient cycle is initiated if there is a patient responsibility portion following adjudication. Nowadays, numerous RCM vendors are providing coding benchmarking, managed-care contracting, analytics, and coding education services to capture all the earned revenue for a practice. No matter the size of a hospital, health system, or practice, failure to prioritize and maintain revenue collection efforts and RCM can hinder growth, create an uncertain financial failure, and increase operational risk.
As per Fortune Business Insights the market is anticipated to reach USD 216,990.6 Million by 2026, exhibiting a CAGR of 12.4% in the forecast period. But, the RCM market was valued at USD 86,811.4 Million in 2018.
Why is Revenue Cycle Management a Complex Procedure?
The focus of several healthcare service providers is on offering top-notch care to their growing patient population. However, attention must also be paid to the financial solvency of the business to make sure that a hospital will be able to provide the same level of care in the upcoming years. Doctors and physicians are persistently faced with the challenge of providing cost-effective care to the patients while witnessing annual increase in administrative and care-delivery costs. Maintaining healthy accounts, preventing and reducing unpaid claims, reducing inefficient billing and coding processes, and enhancing point-of-service collections can severely impact profit margins.
The task of preventing unpaid claims to witness the greatest profit margins is strenuous, considering the nature of healthcare. The healthcare sector is complex as the price to offer services is shouldered by the organizations even before those services are paid either by the patient or the insurance companies. But the claims process is time-consuming. It can take months before a bill is paid in full. According to a survey, more than 95% of medical practice leaders reported inadequate billing processes. The majority of the leaders executed backup efforts to resolve the process by the end of the year. Besides, an inclination towards direct patient responsibility with high deductible health plans from commercial payer reimbursement supports the fact that healthcare service providers must closely examine their RCM and evaluate the methods to achieve multiple benefits.
Key Industry Developments
A rise in the adoption and usage of novel technologies have aided the prominent players in acquiring a lucrative revenue since the past few years. The utilization of RCM software solutions has supported several companies on a global scale. This article further provides insights into a few of the key developments that have recently occurred in the revenue cycle management industry.
Homecare Homebase Launches its New Revenue Cycle Management Service
Homecare Homebase, LLC, a developer of mobile software solutions for home health and hospice agencies, headquartered in Dallas, announced the launch of its new RCM service in June 2019. The latest RCM service is providing part of the organization’s HCHB services suite, a collection of technology-driven services that are designed to reduce the burden of time-consuming administrative operations. Moreover, it reduces in-house billing staff of the agencies by transferring the lion’s share of the collection tasks and administrative billing to a highly skilled team of billing experts.
Additionally, it offers more clarity into the often opaque RCM process for managing agencies through the use of the company’s dashboards and analytics. Homecare’s new service provides an extraordinary return on investment as several agencies are ready to leave money on the table. They are often not ready to spend the time required to resolve all the billing issues. The company’s extensive knowledge and expertise of billing will put it in a unique position.
Apprio, Inc. Unveils its New Commercial Health Unit Named ApprioHealth
In March 2019, Apprio, Inc., a provider of specialized technology solutions, based in Washington, D.C., unveiled its new, commercially focused business unit called ApprioHealth. The unit is aimed to fulfill the revenue cycle management requirements of health systems and hospitals. It will be led by Donny Zamora, who will be the division’s president. ApprioHealth will provide advanced technological solutions and services catered to the needs of the healthcare providers’ revenue cycle. The unit is a perfect blend of Apprio’s highly skilled revenue cycle management team and 20 years of technology experience. The main aim of the new division is to transform the way health systems and hospitals use technology to maximize revenue from existing payers as well as to register patients in the available coverage options.
Into the Future of Revenue Cycle Management Industry
With susceptible relationships enter new challenges that require attention. Payers have to prioritize individuals as buyers of healthcare coverage and healthcare due to the increasing exchanges in ways that they may not have focused as acutely in the past. The future of RCM is fully entangled with the idea of a more accountable customer. Payers are taking multiple actions to prevent and minimize financial glitches. The industry will exhibit a more consumer-centric approach. It would occur as patients are now responsible for a significant part of healthcare revenue due to a rise in the number of high-deductible health plans.
Accenture had surveyed approximately 2,000 consumers regarding medical bill payment. As per the survey, nearly 40% of the consumers mentioned that they would pay their medical bills in advance if they knew the cost beforehand. To increase the likelihood that patients will pay the bills and to guard their revenue streams, hospitals and healthcare companies are likely to maintain their consumer-friendly transparency in the future.
About the author: Reeti Banerjee is currently working as a content writer in a prominent market research firm named Fortune Business Insights. She specializes in writing articles, press releases, blogs, and news reports. She believes in maintaining simplicity throughout her content to provide the clients with a seamless reading experience. Reeti Banerjee on Linkedin