Healthcare - RCM

As the pandemic gradually declines, healthcare is changing its nature towards digitization with the inception of Robotic Process Automation (RPA) and  Artificial Intelligence (AI). The primary reason behind these changes is to reduce the errors and increase the overall profitability. However, a successful healthcare Revenue Cycle Management (RCM) process could be established only by comprehensively creating a solid bond among payers, providers and patients. 

In this article, witness the significant challenges hindering the growth of specialty healthcare and the ways of overcoming them. 

Advance Authorization Process

In the prior authorization process, payers would approve services of the patients even before approval of providers. This process ensures providers give evidence-based treatments to their patients, thereby controlling costs. 

The prior authorization process enables providers to proceed with procedures approved by the payers, which would answer most of the hassles. Hence, outsourcing the initial authorization processes to healthcare RCM service providers could decrease claim denials and substantially increase clean claim rates. 

Revenue Integrity

In this revenue integrity process, charges and codes against the treatments are reviewed and reimbursed appropriately to the physicians or healthcare providers. However, any mistake in this process could prove expensive and it’s imperative to check the effectiveness of reimbursements during the charge entries. 

This is where data interoperability could come into play. First, it helps diagnose and treat patients depending on their unique codes and fee structures. It also helps achieve 98% accuracy and reduce lags during charge entries. 

Appropriate Medical Coding

Specific guidelines need to be followed in medical coding, as it is considered to be one of the complex processes in Healthcare RCM. This is because any improper coding knowledge or coding errors against the given procedures might lead to a dent in the revenue. 

When an outsourcing process is involved, the errors could be minimalized and ensure accurate coding is entered for the treatments and procedures involved. 

Managing A/R Effectively

AR processes help analyze the outstanding claims – pending, low-paid, or denied – and result in timely reimbursements. 

RCM professionals and standard operating procedures could diligently manage A/R processes by following compliance and guidelines. 

Provider Credentialing & Enrolment

Credibility is another critical factor in Healthcare RCM. In this credentialing process, the payers validate physicians or providers to follow the regulations to deliver expected clinical care. This part is essential because the payer might refuse payments if the provider or the physician is not credentialed or enrolled with them. 

This is where credentialing through external sources would prove to be a great fit. The verification specialists ensure the credentialing and enrolment have been done precisely and make way for smooth reimbursements. 

Summing it up

As healthcare providers implement diverse modern technologies in their workflow, it essentially increases the organization’s financial health on the clinical side, with patient engagement tools, reimbursement processes, etc. Now it’s time to join hands with the RCM service providers to make all your processes streamlined, thereby saving time and cost.  

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