Revenue Cycle Management in Healthcare - What is it?
By Nar Ramkissoon
Learn how local health departments can thrive with revenue cycle management.
The departments help curtail the spread of preventable illnesses like the flu through vaccinations, respond to emergencies and outbreaks (the recent Boston bombings show the importance of emergency preparedness), and spread initiatives to end obesity and keep the public healthier.
Recently though, funding for public health has been dropping dramatically, despite demand for the services rising. Federal funding for local health has dropped from $7.3 billion to $6.1 billion since 2005, and twenty-nine states lowered their budgets last year. The Hospital Preparedness Program’s budget (money to help make sure local health departments are prepared in the case of an emergency) dropped from $515 million to $380 million in just the past year.
These recent funding cuts don’t have to bring doom to public health departments though. Through smarter and more efficient billing practices, local health agencies can boost their revenues by up to 70% in a short amount of time. This is where revenue cycle management comes in.
What is Revenue Cycle Management?
Revenue cycle management is the process of making sure you bring in revenue for the services you’re providing, and that the revenue is coming in as close to the time-of-service as possible. That’s it. Implement systems to get paid and get paid fast!
In many ways though, generating and maximizing revenue is actually a foreign thought to most local health departments. The departments tend to be so focused on the health of their communities, that bringing in more revenue to supplement funding can become secondary. Obviously though, with funding dropping it’s more important than ever for local health to begin implementing revenue cycle management.
The Five Steps of Revenue Cycle Management
Capture accurate patient demographic and insurance information prior to service to reduce preventable fraud, claim rejections, and denials downstream. Gathering this information prior to the patient coming in makes their visit to your office quicker, keeping your agency on schedule, and allows you to reschedule the patient ahead of time in the case of insurance not being verified. Insurance verification also shows co-pays and potential patient responsibility.
Payments Prior to Service
Collect all co-pays and the costs your patients are responsible for while they’re still in your offices. It’s much easier to collect face-to-face than it is to send out bills. It seems elementary, but make sure your staff knows to collect while they can.
Quickly generate clean and compliant claims for electronic submission to any carrier, leading to rapid processing and reimbursement turnaround. Revenue cycle management streamlines the entire claims management process by submitting the right claim to the right company the first time, ensuring the quickest possible payment. It can also help eliminate misappropriated staff time spent manually sorting and submitting claims according to the strict reimbursement rules and regulations of each insurance company.
Revenue cycle management helps get all your insurance claims out more efficiently, and also helps bring in reimbursements too. Improved systems can help you better keep track of outstanding reimbursements, ensuring you collect on everything you need to. Reimbursements are a significant revenue source. The average claim reimbursement can be anywhere from $10 - $300, which can have a huge impact on budgets in large quantities.
Automation is a big part of revenue cycle management. Moving to a purely electronic and cloud-based claims processing program will greatly increase efficiency around the office and lower costs. It’s much cheaper to create an online statement for patients than a printed one, and offering online payments is also an easier and more efficient way to collect revenue.
Upp Technology offers an easy-to-implement healthcare claims management solution to help keep public health departments doing great work for our communities. With our program, local health departments can learn how to develop self-sustaining revenue with minimal upfront costs. Learn more about how we make revenue generation for public health easy!