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MHRCM Solutions

CALL US NOW :

(+1) 512 800 6431
(+1) 270 495 3261

MAILING ADDRESS :

sales@mhrcm.com

LOCATION ADDRESS :

Suite 101, 1250 S A W Grimes Blvd, Round Rock, Texas - 78664, USA

MHRCM Solutions

CALL US NOW :

(+1) 512 800 6431
(+1) 270 495 3261

MAILING ADDRESS :

sales@mhrcm.com

LOCATION ADDRESS :

Suite 101, 1250 S A W Grimes Blvd, Round Rock,
Texas - 78664, USA

What are the Benefits of Outsourcing Revenue Cycle Management? 

What is Revenue Cycle Management and How it is Related to Healthcare?

Revenue Cycle Management (RCM) is the financial process used by healthcare facilities to track patient care services provided from registration and appointment scheduling to the final payment of a balance using medical billing software.

Revenue Cycle Management Process is critical in ensuring compliance with healthcare rules and standards, in addition to handling revenue collection and reimbursement. Billing codes, insurance policies, and reimbursement rates must be constantly monitored and updated.

The purpose of Revenue Cycle Management Service is to maximize revenue collection and ensure timely compensation for healthcare provider’s services. This is critical for healthcare company’s financial stability and performance since it directly affects the cash flow and overall profitability.

This involves staying up to date with changes in government regulations and insurance policies, as well as ensuring accurate documentation and coding of patient encounters. By effectively managing the Revenue Cycle Management Process, healthcare organizations can minimize billing errors, reduce claim denials, and maximize revenue generation.

The most critical aspect of Revenue Cycle Management Strategy is reimbursement. It is so crucial that it accounts for around half of a healthcare’s operational revenue. The process by which a hospital or other healthcare provider obtains payment for services provided to patients is known as reimbursement. It is also known as “claims processing”, and it entails filing claims for payment to insurance companies.

Revenue Cycle Management Process is not difficult, but it is a time-consuming procedure that requires a considerable time to move through several departments within a hospital. The Revenue Cycle Management process is dependent on carrying out all policy-making and clinical activities, which include recording, guiding, and collecting particular service information. As a result, it covers everything from patient registration to invoice collection and payment.

Outsourcing Healthcare Revenue Cycle Management

Healthcare Revenue Cycle Management Process and Steps

Healthcare Revenue Cycle Management Process
Revenue Cycle Management in healthcare involves various steps in managing the revenue services. Here are those procedures,
Pre-enrolment

The first step in the Revenue Cycle Management strategy is that it starts even before a patient gets enrolled in the system. Patients’ data, including name, medical history, payer details, and payment mode, are collected. These details are collected prior to the patient’s first visit to the healthcare facility.

Pre-enrolment helps both the patient and the provider. It saves time for the patients before they visit their physicians, as the payment details are sent to the patient at this stage.

As for healthcare, since the payment information is sent to the patients, they may anticipate that their customers will pay their bills on time, lowering the chance of bad debt for the healthcare provider. Pre-enrolment facilitates the procedure and improves the overall patient experience.

The Actual Registration
The patient’s information collected during pre-registration is verified during the registration process, and if there is any error, it will be resolved within this phase, before proceeding further.
Charge Entry 
In healthcare Revenue Cycle Management solutions, Charge Entry is the process by which healthcare professionals enter information about their different services to patient’s database. They subsequently transmit the costs to insurance companies. This metric is critical for Revenue Cycle Management since it ensures that hospitals obtain full reimbursement from their payers.
Utilization Management 
This is the stage at which health insurance companies evaluate and monitor the request for medical treatment. The utilization review will be conducted to determine if the healthcare plan covers critical medical services. It also helps the hospital cut expenses and determine if the offered treatment is suitable.
Medical Coding
Medical Coding is used to transform textual descriptions of services, procedures, and individual requirements into alphanumeric or numeric codes. They are utilized to assist hospitals in creating a process map. Medical codes are used to generate insurance invoices and claims from patients’ medical data.
Eligibility Verification
Benefits and Eligibility Verification is yet another critical stage in the Revenue Cycle Management Process. If it’s practiced effectively, it would result in a higher clean claims rate. We can avoid delayed payments, invoicing issues, and failure to receive payments by maintaining an easy and quick Eligibility Verification procedure. Healthcare professionals must have periodic inspections to ensure the coverage and benefits offered by the insurance plan.
Claim Submission
One of the most important Revenue Cycle Management processes in Medical Billing is the submission of medical insurance claims. During claim entry, the healthcare provider will submit claims to insurance companies so that payments may be delivered in accordance with the terms of the contract.
Denial Management
After Claim Submission, in the Denial Management phase, the claim approval status will be defined. Healthcare’s Accounts Receivable Management team examines the payment received from the insurance provider or payer. They are monitored to ensure whether the payment is approved or if there is a discrepancy that is causing the payment to be delayed. In the case of an error, the claim may be forwarded to the clearinghouse, where it will be evaluated and cleared.
Regular Followups
Denials are typically the consequence of inaccuracies in medical billing codes, inadequate patient information, or questions about the patient’s coverage. Regular follow-up on the claim submission will reduce the denials and provide maximum coverage for healthcare.
Billing and Collections
The final phase of the healthcare Revenue Cycle Management Process is to assess patient balances and liabilities and create a statement. Outstanding accounts are closely monitored. Payment balances of various patients are tracked, and the outstanding payments are collected.

Outsourcing Revenue Cycle Management Service

Controlling the full Revenue Cycle Management Process might be a complex process in a healthcare system. Having enough skilled people on hand to support the various revenue cycle activities might be a challenge for your resources. However, it becomes a much more difficult effort when you have to account for compliance as well as the ever-changing laws and regulations that govern the healthcare business. You need professional support in order to maintain a consistent process.

You can increase revenue cycle efficiency in your healthcare by outsourcing to professional Revenue Cycle Management service providers like MHRCM. Outsourcing RCM enables you to concentrate on patients while professionals manage your processes.

Benefits of Outsourcing Revenue Cycle Management Process Cost Saving

Outsourcing Revenue Cycle Management Process brings in more cost savings than operating it in-house. Revenue Cycle Management outsourcing allows healthcare firms to save money on labor and expenses while maintaining or even increasing the quality of their Revenue Cycle Management.
Benefits of Outsourcing RCM Process
Increased Revenue
Another significant advantage of outsourcing Revenue Cycle Management is the possibility of higher income. Outsourcing can result in greater income for healthcare companies by improving revenue capture, shortening payment timelines, and improving Denial Management.
Improved Revenue Cycle
Outsourcing Revenue Cycle Management can also result in shorter payment cycles, improved cash flow, and less collection time and effort. Outsourcing firms provide the resources and technology required to handle payments quickly and effectively, resulting in faster reimbursements for healthcare providers.
Better Denial Management
Outsourcing Revenue Cycle Management may also contribute to better Denial Management, which can lower the number of claims neglected, and save on claim costs due to denials.
Leverage the Technology
Outsourcing Revenue Cycle Management allows healthcare firms to have access to innovative technology that they would not be able to deploy in-house. This includes Billing, Medical Coding, Collections, and other parts of Revenue Cycle Management software and hardware. Healthcare firms that outsource can make use of cutting-edge technologies to improve their operations and remain competitive.
Reporting and Analytics
Outsourcing Revenue Cycle Management may also help healthcare firms enhance their Reporting and Analytics. Outsourcing firms provide the skills and resources required to gather and evaluate Revenue Cycle Management data. Healthcare organizations may use this to discover patterns, monitor Key Performance Indicators, and make data-driven decisions in order to optimize their Revenue Cycle Management Strategy.
Focus on Your Core Service
Revenue Cycle Management outsourcing allows healthcare firms to focus on patient care. Healthcare firms may decrease administrative burdens on their personnel and focus on providing the highest quality care to their patients by outsourcing Revenue Cycle Management services to dedicated teams like MHRCM.
Focus on Strategic Management

Outsourcing Revenue Cycle Management can allow healthcare firms to focus on strategic planning. Healthcare firms may free up resources and staff by outsourcing Revenue Cycle Management Processes, allowing them to focus on strategic projects such as increasing Medical Billing Services or improving patient outcomes.

To Conclude

If you are planning to outsource Revenue Cycle Management Services, here are some reasons that you could be interested with MHRCM RCM service,

MHRCM RCM smoothly supports healthcare organizations’ infrastructure through a flexible engagement strategy, generating lasting increases in revenue and cash flow while decreasing operational expenses and denials.

MHRCM is ready to take the lead if your healthcare organization is seeking an experienced partner for outsourced Revenue Cycle Management Process. Our team is dedicated to working with customers to provide solutions that help them optimize their operations, increase revenue, and reduce billing errors.

Related Resource

About the Author

Elena Kinsley

Elena Kinsley is a seasoned Content Strategist and Chief Technology Officer (CTO) specializing in medical revenue cycle management (RCM).

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