RCM services for hospitals are handled quite differently compared to physician billing. The services for hospitals include administrative and clinical functions that contribute to capture, manage and collect patient revenue. Hospitals traditionally rely on disparate administrative and clinical functions in order to optimize the revenue cycle from end to end.
An organized end to end RCM services for hospitals are divided into three areas. They are patient access, mid revenue cycle and patient revenue services. Critical information has historically been captured and processed to bill the services within these areas. Based on the trends identified, it’s believed that current market forces, right from increasing patient liability to consumerism has the need to go beyond incremental improvement in the revenue cycle to true transformation.
How do RCM services for hospitals define Patient to Payment?
- To get it easier, patient to payment is all about helping healthcare professionals and hospitals to get paid for their services rendered to patients.
- RCM services for hospitals and healthcare professionals also ensure the payments to be faster and accurate by decreasing complexities and eliminating administrative burden.
- Starting from the point of access, it’s more about supporting healthcare organizations with strategies and capabilities throughout the patient care, resulting in timely reimbursements.
- Patient to Payment actually works for a complete revenue cycle optimization, and resolving business challenges across the entire spectrum of the revenue cycle management process.
- Apparently, it requires a micro view to examine the operations at every step of the process and also see how they affect the revenue outcomes.
Patient Access:
- Patient access is the base for the whole revenue cycle management process across all functional areas.
- RCM services for hospitals can minimize denials of healthcare professionals and reclaim the process after corrections by streamlining and increasing patient responsibility as well as satisfaction.
- Inaccuracies in scheduling and registration can create major data collection and revenue problems, both for the patient and the hospitals.
- Required demographic details that hospitals must capture during patient access are:
- Photo Identification
- Date of Birth
- Social Security Number
- Address and
- Employer
- In addition to this, patient access also should capture insurance details, such as:
- Insurance company and policy number
- Reason for the visit.
- Establishing mere financial clearance and beginning the process of patient collections is a crucial part of any Patient Access responsibilities.
- Attempts to collect patient’s out of pocket at the point of service is considered to enhance patient collections and reduce workload.
- Establishing financial clearance means, collecting accurate documentation that includes:
- Service authorization based on referral or pre-certification information.
- Insurance verification based on eligibility and benefits.
- Payments that are referred to as POS must include:
- Collection of patient’s co-pays and deductibles.
- Applying any appropriate discounts
- Resolution of prior account balances.
- Currently, hospitals are supposed to make their service pricing lists public in order to meet the government’s requirements for public accountability and transparency.
- Patient access should be able to provide correct estimates based on the pricing by enabling patients to compare facilities with other hospitals.
- It’s also stated as the beginning process of RCM services for hospitals that collects the data or information to ensure compliance with State and Federal regulations. They include:
- Financial responsibility acknowledgement form
- Authorization to release protected health information.
- Relation of admission or procedure to workers’ compensation or automobile accident.
- Advance beneficiary notice collection.
The Mid Revenue Cycle – (RCM services for Hospitals)
- RCM services for hospitals focus on accurate and complete clinical documentation, coding and charge entry process in the middle of revenue cycle process.
- Clinical Documentation creates an entire and thorough record on diagnoses services, symptoms observed, treatment procedures that are planned and executed, patient care provided, including an outcome of treatment along with clinical assessment of the entire process.
- If there’s no documentation, then it’s believed that treatment didn’t happen or take place.
- With the help of clinical documentation integrity, the entire document is reviewed to confirm whether it reflects the severity of disease and intensity of treatment services rendered.
- It also ensures that the coding process is in alphanumeric codes which results in immediate revenue payments or reimbursements.
- The coding types are :
- Concurrent review of documents aid in filling gaps between healthcare professionals’ documentation and services in real time.
- Charges are captured in the middle of revenue cycle process. They are captured as by-product of orders entered directly into the electronic Health record system by healthcare providers or after when the service is rendered and documented by office staff. At times charges are directly entered into EHR.
- Record charges include laboratories, consultations, medications, procedures and supplies.
Patient to Payment:
- RCM services for hospitals are as important as patient care from healthcare providers. So, revenue cycle services must be full packed with robust patient access to clinical documentation and medical coding for payments.
- Errors in scheduling and registration will definitely impact claim processing and eventually result in rejections and denials of the claim.
- Patient to payment work on these challenges with a comprehensive set of capabilities that helps to solve revenue issues across the entire spectrum of revenue cycle process.
- These capabilities include a range of solutions, right from revenue cycle software to technology-enabled services, strategic outsourcing solutions, advisory services, analytics and education.
- Patient-to-Payment approach also leverages these capabilities based on individual client requirements by first identifying business issues and their root causes, followed with an implementation of customized, integrated solutions that include one or more solutions to transform revenue cycle.
- Outsourcing RCM services for hospitals with the right medical billing company means gaining access to business technology that makes an advanced data analysis and bench marking possible.
- With no surprise, this kind of strategic partnership is a growing trend. Studies have revealed that outsourcing revenue cycle services and properly managing portions of it can actually expect increase revenue reimbursements.
Outsource for Better Efficiency
Improving the revenue cycle efficiency is a great hurdle that the healthcare organizations need to cross before they can make their cash flow error-free. However, most hospitals and provider organizations fall behind in this goal because they suffer from staff shortages. The decreasing workforce has been a significant issue especially in the time following the pandemic. Organizations with even dedicated teams are not able to keep up with the complex workflow like AR analysis, follow-up and patient collections. Keeping all these reasons in mind, more than 30% of the healthcare organizations outsource their RCM to professional RCM companies.
The global healthcare RCM outsourcing market size is predicted to be worth USD 29 billion by 2026. Tying up with a global RCM company can boost your revenue flow and improve the daily efficiency of your in-house team. RCM companies follow repeatable models of growth with proven positive results. Engage your in-house staff to carry out more complicated decision-making part of the process while the expert RCM professionals keep your revenue flow strong.
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