7 Best Practices for Revenue Cycle Management



The healthcare industry is quite different from other businesses as clinical treatment is not a succinct or lone transaction and subject to complex procedures starting from a patient’s appointment to his/her account closure. Since the inception of ICD-10, medical practitioners are now required to undertake hours of ICD-10 training in order to ensure competence with the new medical coding system. The healthcare industry is also entrenched with uncertainties of uncollectible, health information exchange and financial performance. Thus, the providers need to streamline their Revenue Cycle to make the business profitable.

According to the National Health Insurer Report Card,19.3% of claims paid by commercial insurance companies are incorrect. Hospitals don’t collect 4%-12% of the money they are entitled to and the patient’s liability is around 30% of the practice income.  Revenue Cycle Management comes as a handy tool to consolidate the healthcare computing environment and to enhance physical reimbursement. Revenue Cycle Management is associated with claim handling, revenue generation, and payment management.

Healthcare Industry has identified the market potential of digital-physical amalgamation where best methods are capitalized and collated to a stringent safekeeping record. Now, who wouldn’t invest and adopt the practices that will emanate a preponderant societal impact?

Here are a few Best Practices that a healthcare facility needs to augment to gratify the missing/omitted recent advancements in the healthcare industry:-

  1. Adhering to Compliance Standards: 

    In forever varying medical regulations, healthcare organizations have to adhere to HIPAA compliance standards. HIPAA requires the standardization of medical codes used by coders and billers and makes it compulsory for all the healthcare providers and medical billers covered by HIPAA to submit claims electronically using an approved format. Manual record-keeping often augments into delinquency and it’s imperative to employ proper strategies to secure the records according to HIPAA. The healthcare providers can safeguard the privacy, security, and confidentiality of protected health information (PHI) by adhering to the compliance standards of HIPAA.

  2. Leveraging Expertise of Renowned Healthcare Service Provider: 

    Medical Billing and Coding have grown substantially and it is not cost-effective for a healthcare provider to go through its granular level, moreover, it’s also time-consuming at a large scale. ICD-10 is now accepted across every healthcare organization and the majority of the complexities in ICD-10 lies in enhancing the specificity of documenting diagnose. The healthcare industries are relying on third-party vendors to handle high-volume transactions and maximize their operating margins. Healthcare service providers track the coding and billing procedures with the help of their expertise and trim a lot of monumental paperwork. Patients also enjoy the fact that this has created a greater degree of transparency in the Medical Billing of the healthcare systems.

  3. Utilizing Interoperability between Health Systems: 

    Interoperability solutions for communicating a patient’s medical information across various healthcare components is one particular technological development that is shaping healthcare organizations. Various other landscapes of the healthcare sector are interconnected which has changed the workflow requirement, ultimately easing the work of providers. Health information exchanges are an important part of the overall healthcare landscape, and it will substantially grow in the future. With the constant changes in the medical regulations, interoperability will definitely help the healthcare providers.

  4. Bridging Gap between Business & Clinical Side of Healthcare: 

    The Healthcare industry follows a strict approach in improving the clinical payoffs; they train their clinicians and a host of other non-clinical staff. However, the other non-medical services like Insurance verification, billing, follow-up, collections, payments, etc., fall under the providers’ revenue cycle. There is an utmost need to modulate medical billing from the prime business.

  5. Diversification with a stated intent of Patient-Centered Approach: 

    Apart from the monetary savings, physicians can depend on billing companies to improve efficiency and to enhance employee utilization within their office, thus increasing their reimbursement rate. A physician’s time and effort should be directed towards the patient, not towards the struggle with revenue cycle management.

    A patient’s experience is consequential and the hospitals are functioning hard to render the best care for their patients, also keeping in mind that they are not clutching them very hard that they refuse the healthcare facility the next time. An expert healthcare service provider ensures a distinct and validated approach that gratifies a patient’s need without overwhelming them.

  6. Conjuring an Exemplary & Predictable Cash Flow: 

    There is a marked difference in the treatment plans on the availability of resources and the realities of local conditions. According to the American Medical Association (AMA), up to 10% of claims are not paid correctly. Often, typical hospitals, even if are able to employ experts, they charge enormous money. These professionals are generally not equipped with advanced methodologies, in such a scenario taking professional help is preferable as medical billing experts exercise efficient Revenue Cycle Management tools to accurately record, safe-keep, and dispatch claim settlements.

  7. Mitigating the Inaccurate Collateral Data: 

    It’s in the hospital’s best interest to have an implicit Revenue Cycle Management system to handle the financial pressures as there are numerous instances of Billing, Collection, and Coding errors. Their business challenge, then, is “Collating the systematic Medical Billing revenue”, invariably, things go wrong, and there are discrepancies between back-end system records and the field reality. Something is omitted or left behind. Something is miscounted. Researchers from California Nurse Association found that 22% of the claims submitted were rejected. And almost 40% of the rejected claim has never been resubmitted. The reasons are claims being lost or missed or not meeting the deadline etc. An effective Revenue Cycle minimizes the claim rejection/denial and generates income for the healthcare facility.

Since investment in the RCM system is a long-term expense, organizations should go over their options and opt for an experienced RCM service provider. Adopting the best practices outlined above, a healthcare facility can streamline the revenue cycle and focus on its core business.

For more information on how Invensis Technologies will deliver value to your business through our Revenue Cycle Management (RCM) Outsourcing Services please contact our team on US +1-302-261-9036; UK +44-203-411-0183; AUS +61-3-8820-5183; IND +91-80-4115-5233; or write to us at sales {at} invensis {dot} net


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