The revenue cycle management (RCM) process in healthcare is a long and complex one. From gaining prior authorization (PA), to scheduling, to pre-registration, through gaining final payments, organizations must juggle these moving pieces, as well as manage the ever-changing financial obligations and demands of patients.

So let’s tackle some of the most frequently asked questions.

What is Revenue Cycle Management?

In the most basic terms, revenue cycle management is the process of tracking a patient’s journey through the entire course of their care process, from their first appointment all the way through to the collection of their final payment. This includes, but is not limited to:

• Patient Scheduling
• Pre-Registration
• Prior Authorization
• Claim Status
• Insurance Follow-up
• Denials Management
• Patient Pay Follow-up

An effective revenue cycle management software platform provides intelligent workflow and centralized automation, along with the contact management and omnichannel tools  to drive increased payments and bring accounts to resolution. This software empowers an RCM workforce while creating a positive financial experience for patients.

Why is RCM so important in healthcare and to hospitals?

Hospitals and health systems traditionally have a primary mission — to focus on providing quality patient care to the communities they serve. Even with the change of the healthcare landscape over the past decade — which includes the major trend of U.S. employers transitioning to high-deductible health plans (HDHPs), that according to one report, increased from 13 percent in 2010 to 29 percent in 2022 —many providers, especially post-COVID, still struggle to staff, train, and retain employees to fill the critical role of RCM departments.

This ongoing and increasing shift from insurance companies carrying a significant amount of the financial responsibilities to the patients assuming that responsibility means hospital providers have to become more diligent in their efforts to not only collect upon the payments due, but to do it in a way that humanizes the patient experience.

But the right RCM software solution can equip hospitals with the technology necessary to collect cash more quickly, all while increasing patient satisfaction.

What are the benefits of an effective Revenue Cycle Management platform?

There are many benefits associated with investing in and maintaining a healthy RCM platform.

Through intelligent, centralized automation, you will:

• Free up staff for higher-yielding activities with exception-based redundant task automation through RPA and AI technologies
• Reduce denials and write-offs by automating prioritized, optimized presentation of accounts for follow-up
• Create a seamless workflow environment through system agnostic bi-directional integration
• Enable intelligent business decision making through root cause analysis spanning the revenue cycle continuum

With transparent workforce empowerment, you will:

• Eliminate data navigation slowdowns with aggregation of patient, payer, and account level data under a single platform
• Accelerate the path to resolution through automation and omnichannel patient engagement
• Increase payer follow-up results through like-account groupings, simplified billing frequency management, account spanning, and an optimized payer calling experience
• Create easily digestible visualization of performance KPI’s at all levels of the organization
• Supervise, enable, and improve remote and in-office staff with superior workforce management and quality assurance tools

You are able to offer a humanized patient experience with:

• Tailored, individual patient communication methods and frequencies foster timely self-service responses
• Affordability based payment options put the patient in control of their financial decision making
• AI-driven, dynamic P2P segmentation strategies drive the highest probability of payment
• Patient profiles enriched with alternative data personalize the approach to financial care by creating an in-depth understanding of their financial capacity
• Robust contact matching and account tying simplifies medical debt management for patients and contact management for staff

When should Revenue Cycle Management be outsourced?

As we’ve already established, revenue cycle management has many moving parts. From initial contact, to determining eligibility, gaining prior authorizations, monitoring claim statuses, staying on top of insurance follow-up, managing denials, and collecting patient payments — managing it all is challenging, to say the least. And now in the aftermath of the COVID pandemic, healthcare financial management leaders are also dealing with a workforce shortage.

For some providers, outsourcing to a third-party agency—or using an extended business office (EBO) — to help with their revenue cycle management makes sense.

While providers aren’t necessarily “in the business” of collecting payments, revenue cycle management outsourcing companies certainly are. A trusted outsourcing partner can work as an extension of a health system, and they come equipped with the technology and resources to do what they do best, allowing hospitals to focus on what they do best — provide quality patient care.

We’ve just scratched the surface on the topic of revenue cycle management. If you want to learn more about RCM technology, or are interested in an RCM software solution, visit Finvi.

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