A lot goes on behind the scenes when a patient visits a healthcare facility. Personnel at the centers must do things the right way every time. The revenue cycle itself starts with taking the patient’s details upon check-in, including capturing insurance information directly from the patients. This process ensures timely claim submission and prevents insurance fraud by confirming demographic details match the insurance policy.
Then there are the billing and diagnosis codes. In healthcare, these codes link everything together, making sure that service provider knows what goes where and why. Once the patient visit is coded and complete, attention turns to the charge submission and reimbursement part of the revenue cycle. And finally, collection occurs through insurance or whatever method the patient chooses to cover the services received.
What’s the importance of RCM?
A good RCM provider brings together different things that make up a healthcare facility’s revenue collection process. Typically, siloed groups do the work. The good thing about RCM providers is that it’s like having a full-time project manager. That way, getting everyone to do their work correctly is easier.
Much of the work involves gathering diagnosis codes and medical notes. There’s also time to enter patient details and make sure that everyone is using the right billing codes. This bit is super-important because everything should match what the patient got from the provider.
The aim is to make sure that things work better and it’s profitable for the healthcare providers. That’s why Vipin Adhlakha feels an RCM system is worthwhile, even if expensive. Providers who use it see a jump in how much they get reimbursed. At the same time, they find it easier to adhere to what the law wants them to do.
Another good thing about RCM is that everyone gets a good deal. On the one side, providers reduce little liability while making the most of what they get through reimbursements. Over and above that, they also become efficient.
Patients also get something out of the RCM. They don’t have to worry about mixups that cause delays. That way, patients enjoy a good experience every time they’re at the hospital or clinic.
RCM and value-based care
Adhlakha believes RCM could do something special for the healthcare sector. It could help organizations find ways to do away with the fee-for-service model. That way, they get rewarded using value-based reimbursement. RCM systems have one thing going for them – data analytics.
With this capability, payers and providers find it easier to get a good look at patient data. That info is gold. It lets them figure out many things. At any rate, they want to know how many people come to hospitals for treatment. And the conditions affecting them, including age groups and that sort of data.
Access to this data is more important now that new legislation MACRA (2015), wants healthcare providers to switch to value-based care and reimbursement.
About Vipin Adhlakha
Vipin Adhlakha is a fully qualified medical professional. He has a master’s degree in molecular biology from Purdue University. Over the years, he co-founded an Indian biomedical professionals group, served on several diagnostic industry expert panels, and has an ongoing commitment to STEM educational and vocational development.
