RCM or revenue cycle management is a financial process that healthcare facilities use to track patients from the moment they make an appointment to the final payment of all the medical charges.
RCM in healthcare combines both, business and clinical aspects, making it a more cohesive process. It uses the patient’s name, insurance policy, and other relevant details and sends out billing information to the patient’s insurance company after they have received the treatment. Billing details are in the form of codes that help identifying which parts of the treatment were covered by the insurance company and which will be paid by the patient.
Revenue cycle management in healthcare includes documentation, eligibility for insurance, demographic entry, billing and coding, and filing claims. If these things are not managed properly, it will lead to chaos.
A certain move towards a more holistic patient care has allowed healthcare providers to take a closer look at RCM in healthcare and the way they approach it. Poor billing can result in a financial loss for the patients and there is a risk of affecting the quality of healthcare.
RCM needs to evolve if the hospital wants to provide not only their patients but also their healthcare workers with an efficient system so that they are able to provide better care for each patient.
The Challenges of RCM in Healthcare
While it may seem that RCM in healthcare is a fairly streamlined process, this is not the case for most hospitals. Contrary to popular belief, RCM is a very delicate process and there are things that can go wrong such as coding problems, spelling errors, and duplicated data, which may lead to billing errors or missing critical information. These seem like small technical problems, but they can result in revenue losses for hospitals or insurance claim mishaps for the patients.
The changing healthcare regulations and reimbursement options make it harder to receive timely reimbursement. For healthcare providers to achieve successful revenue cycle management, they must improve their administrative efficiency.
Collection of payment is a long and daunting process for healthcare workers as the processing of billing and claims takes a significant amount of time, and there are instances when these claims are denied owing to ineligibility. This has also led to the insurance companies making the policies and procedures more complexed in order to combat healthcare fraud and abuse.
Another major problem with digital RCM is that because the departments are not exchanging information, the hospital might have to bear the healthcare costs. If the hospital wants smooth functioning, then they have to incorporate digitalized means so that the process can be smooth and the hospital does not have to pay for any additional costs out of their own pocket.
Digitalized records of patients will allow different departments to improve the sharing process by being able to access the information freely through a software. It will also allow the hospital staff to keep track of claims through their lifecycle.
How the World Is Moving Towards Digital RCM in Healthcare
The only way to combat the problem of human error is to move the process of RCM and digitalize it. Digitalizing the RCM process means incorporating automation, artificial intelligence, and block-chain solutions so that healthcare providers can accomplish their business goals, and this makes RCM a more streamlined process. It is recorded that two out of three patients never pay their hospital bills in full.
These problems of the medical bills being underpaid and leading to errors are all due to faulty RCM in healthcare. This may be due to management or administrative problems, but RCM needs to move to the digital sphere so that hospitals can get the payment more efficiently.
Human management pales in comparison with digital RCM. Even if we automate one aspect of revenue cycle management such as identifying the eligibility of the patients, it can result in reduced costs that can be put to better use somewhere else in the hospital.
According to Cognizant Perspectives, “Providers may use digital RCM based tools to estimate their costs of collection and quantify benefits, demonstrating digital RCM’s value and profitability. Providers can deploy dRCM solutions relatively quickly to optimize and increasingly automate RCM operations, following a path that eventually will lead to no-touch claims processing.”
Digital RCM Is the Future of Healthcare
Revenue Cycle Management healthcare has undergone a drastic change over the last year during the COVID-19 pandemic. Many hospitals have had to embrace and cope with to the new digital approach because of the increasing demand for digital RCM in healthcare so that patients can pay their medical bills online and are able to access their clinical and financial information through digitalized means.
It is reported that one in three Americans are frustrated with the hospital billing process or the billing process in general. Responding to this demand, healthcare providers are turning towards digital solutions so they can have better insights into patient engagement leading to better care as well as ensure a more efficient revenue cycle management.
The shift towards digital RCM in healthcare has been quite sudden because of COVID-19. It has now become inevitable for healthcare providers to move towards a digitalized option considering the drastic impact that the pandemic has posed on the revenue cycle management of hospitals. Cost reduction by opting for a digitalized option is indeed a smart choice!
Being digitalized means being able to see your billing and payments through messages and make online payments, which make the process of healthcare more streamlined for both, the hospital and the patients.
Digital intake and self-scheduling assisted by the digital RCM process help the hospital take information for the billing beforehand and verify whether the patients are accounted for prior to the appointment.
While COVID-19 has forced healthcare providers into opting for digital means, the majority of the patients have been waiting for these changes for a long time. Not only is it convenient but also saves time for both parties.
Problems in Digitalizing RCM Healthcare
Digitalizing the healthcare system will improve efficiency in hospital management but there are several things that need to be taken into account if the hospitals are to move towards digital RCM.
If healthcare providers decide to do this, then they need to take the users into account and make life easier for them. These users are the healthcare professionals such as doctors, nurses, orderlies, and medical staff whose focus is on delivering care to patients.
Moving to digital means is the correct option but it can be very difficult for the hospitals to change their whole process and start from scratch through digitalized means. Hospitals are hesitant because not only is it a big step, but it is also relatively expensive.
However, it is a worthy investment that will help the hospital gain more in the long term. What the healthcare providers must take into account is what technology they will choose to digitalize their revenue cycle management. Even if they get the correct technology and can successfully put up a digitalized system, there is another challenge of training the hospital staff on the software.
While digitalization is a difficult process and there are many hurdles one must cross to have a successful implementation, the advantages it provides to medical professionals outweigh everything else.
Through continuous innovation, RCM in healthcare has gone through significant changes and digitalizing RCM will eliminate manual processes and reduce the labour costs required to submit a clean claim and receive timely reimbursement.
RCM in healthcare is a process that helps the hospital staff manage holistic care provided to the patients. Since it has been done manually for a long time, there are bound to be human errors. The hospital is suffering because the majority of the people never fully pay their hospital bills because of some processing problem.
Digitalizing will help the hospitals make the process of revenue cycle management easier and minimize user errors. This will also help the patients since they will be able to make payments online and also get their bills online.
Additionally, this will also help the hospitals because through means of self-scheduling, the patients will be required to fill in the information necessary for payments beforehand and it will allow the hospitals to check if the patients are accounted for before the appointment.
However, digitalizing RCM in healthcare can be very difficult. It is costly and requires a well-informed decision while choosing the technology that will be the most suited to your hospital needs. The hospitals will also have to teach their staff on the use the technology effectively.
Nevertheless, considering the business results and efficiency in care it offers, investing in digitalizing RCM in healthcare is the right step to streamline the process in the long term and is worth the investment.