The Ultimate Guide to Healthcare Revenue Cycle Management in 2021December 15, 2020
What is Revenue Cycle Management - An Overview
Revenue Cycle Management (conveniently referred to as RCM) is a business process service that helps healthcare entities manage their billing better by reducing denials and improving profitability on every medical transaction.
The complete administration and management of financial transactions starting from the beginning of the patients’ journey all the way to its completion falls under the umbrella of healthcare revenue cycle management.
This includes documentation, billing, collections, insurance, medical coding, data analytics, management, compliance, post-medical services and so on.
While there’s a perception that revenue cycle management is primarily medical billing, true RCM experts understand that medical billing is just one of the many core components of a successful RCM process.
Steps Involved in Successful Healthcare Revenue Cycle Management
As a process, RCM encompasses a series of steps that lead to providers getting paid on time by insurance companies for services they have rendered to patients.
For this process to succeed, each step has to be managed efficiently, starting with front-end tasks like appointment scheduling and insurance eligibility verification with the help of professional medical coders and clinical coders.
Designing and implementing onsite-services such as a unit dedicated to insurance-oriented patient journey and pre-authorization management represent the first of two phases of RCM.
Pre-visit eligibility check is crucial as this enables hospital staff to collect patient information and verify a patient’s insurance coverage before an appointment.
This step not only improves the patient experience during the actual visit, but it also avoids possible billing delays and reduces the volume of denied claims due to insurance ineligibility.
The second phase of RCM involves the conversion of collected information into a format that can be supplied to payers, using codes for reimbursement processing.
This is currently done in the form of electronic claims (e-claims) and involves back-end tasks such as coding, claims submission, payment posting, statement processing and management of denied claims.
Having a cohesive structure in place improves time management, communication, regulatory compliance, and the ability to spot possible coding and billing oversight, allowing providers to maximise revenue cycle opportunities at point of care.
Watch this explainer video to understand the complete RCM journey
Why is Revenue Cycle Management Necessary?
According to the NHA (National Health Account), the UAE leads the Gulf, Arab and Eastern Mediterranean countries in terms of the Current Health Expenditure per Capita (CHE_pc).
Moreover, the results also demonstrated that UAE’s health financing system is sustainable, with the mandatory spending reaching 83% of the total spending on healthcare.
On one hand, these figures are a testament to the rising demand of healthcare facilities that’s supported by a robust healthcare system.
On the other, healthcare facilities have to cope up with these voluminous transactions while taking steps to maintain the health of their revenue cycle and improve profitability.
In the Middle East, revenue cycle management remains at a nascent stage.
However, its prospects are bright as the region’s healthcare market holds untapped potential.
According to industry estimates, healthcare spending in the wider Middle East and North Africa (MENA) is expected to reach USD144 billion by 2020.
The Middle Eastern healthcare market is also evolving with new regulations, laws, systems, processes and financial dynamics, making RCM a cornerstone in the healthcare industry.
In addition to that, the Global Revenue Cycle Management Market is on the growth trajectory as it's expected to grow from USD 57,949.30 Million last year to USD 114,519.97 Million by 2025
Additionally, the global outbreak of COVID-19 has been a major cause of concern for healthcare providers who are on the frontline of testing and treating infected individuals.
Among their concerns is the impact COVID-19 will have on the healthcare revenue cycle and financial operations.
Keeping the billing office running during an outbreak is key to keeping hospitals and practices open for infected individuals requiring care.
But this can be a challenge, especially for smaller organizations with limited cash on hand to respond to COVID-19 demands.
That’s where Revenue Cycle Management Companies step in.
They act like your extended arm to process the volume of medical billing and coding requirements while helping you reduce rejections and denials.
In an effort to soften the long-term impact to the bottom line due to the current crisis, hospital CFOs should start exploring financial mechanisms that will allow them to weather this current storm.
One of most robust steps is to hire expert RCM companies to deal with growing coding backlogs and anticipated AR backlogs.
How to hire the right Revenue Cycle Management Company in 2021?
Whether it’s your first time hiring a revenue cycle management company in the UAE or Saudi Arabia, or you’re looking for a change, following are the minimum criteria every RCM company should meet:
Level of Expertise:
Research about their expertise in the region you operate.
The right RCM company is experienced and well-known within the healthcare industry.
Browse their website, case-studies and publicly available data to gather insights on their expertise.
The ideal RCM company will be transparent with their processes and progress.
They should not keep you under any sort of ambiguity related to your data and medical billings.
Ask them about their data security policies and precautions to make a decision before signing up with them.
Healthcare is one of the most versatile and ever-evolving industries.
The ideal RCM company keeps itself updated with the latest transformation in the industry.
When you’re evaluating the most-promising RCM companies, take into account their adaptability with the newest industry trends.
Remember - their lack of adopting global standards in RCM can affect your healthcare practice too.
After all, it’s not just about them. It’s about you too.
Ease of Communication:
Ask yourself - Are they easy to deal with?
Can you communicate comfortably with them and expect timely replies on your queries?
Do they assign you an account manager for your day-to-day correspondence?
Get to know their processes and onboading requirements to gauge whether it meets your level of satisfaction.
Accolades, Accomplishments & Accreditations:
The best revenue cycle management companies are committed to business excellence, including the systematic use of Quality Management principles and tools in Revenue Cycle Management and medical claims processing that improve performance and lead to enhanced customer experience.
Their business excellence framework is ideally designed to achieve Assurance, Control and Continual improvement of services provided to clients.
After all, healthcare can be risky without the presence of governing bodies who ensure quality control and compliance.
Check whether your prospective RCM company meets the necessary requirements and is accredited by healthcare management bodies.
Their website or brochure should display quality control measures like ISO International Standards and Process Management Accreditations.
Review them before making a call.