Healthcare revenue cycle management or RCM is a process by which providers track and manage their revenue. In simple terms—it’s your billing process. RCM encompasses everything from claims submission and payment processing to patient and insurance collections. It also involves following up with payers when claims are denied, which industry sources put at anywhere between 5-25% of claims submitted.
Billing issues can stem from a variety of reasons, but the most common are due to simple human error, such as data entry mistakes and coding errors. Additionally, many outpatient clinics, hospice agencies and other healthcare providers still manage billing through highly manual processes, making it easy for staff to miss important steps such as verifying patient eligibility or ensuring the required referrals and authorizations are in place.
Unless the provider checks these details before care is administered, the patient could be stuck with the bill. This often leads to lost revenue for the provider, given how difficult it can be to collect on overdue or delinquent payments. According to a 2014 report from the Consumer Financial Protection Bureau, at least 43 million Americans have overdue medical bills on their credit reports.
Effective RCM Strategies
Healthcare EMR and billing solutions, including PT software, therapy software and hospice billing software, should have capabilities to streamline billing and support a smooth RCM process. But the reality is that many providers operate with limited staff, time and resources. Moreover, many staff multitask in various roles, which can make it difficult to stay on top of coding changes, payer requirements, patient paperwork and collections.
That’s why many healthcare organizations are now looking at outsourced RCM services to support their billing process. According to research, the global healthcare RCM outsourcing market is expected to grow from $11.7 billion in 2017 to $23 billion by the end of 2023.
When deciding your RCM strategy, it’s helpful to identify key factors that could impact your decision, such as your budget, management style, comfort level and current infrastructure.
The following includes a few questions to ask as you consider whether to do your billing in-house or outsource to a third-party provider.Are your billing staff up-to-date on regulations that may impact reimbursement?
- Are your billing staff up-to-date on regulations that may impact reimbursement?
- Are you experiencing a lot of back-office staff turnover?
- Can you effectively scale your billing process to support growth, or are you relying on manual processes and spreadsheets?
To learn how RCM services can support your hospice agency or outpatient therapy practice, check out the below resources:
- Hospice RCM Calculator
- Optima RCM for Hospice
- Should You Outsource Your Therapy Billing?
- Optima RCM for Therapy