Overview of Revenue Cycle Management (RCM)
Revenue Cycle Management is the process of managing the financial lifecycle of a healthcare provider, from patient registration to the final payment of balances. Effective RCM ensures accuracy, efficiency, and compliance, reducing delays and maximizing revenue.
Core Components of RCM
Patient Registration & Scheduling
Process: Collect and verify patient demographics, insurance details, and authorization.
Tech Integration: Use automated tools for eligibility checks.
Outcome: Improved first-time claim acceptance and a streamlined patient intake process.
Insurance Verification and Authorization
Process: Validate patient coverage and obtain pre-authorizations before services.
Compliance: Adhere to payer policies and guidelines.
Outcome: Fewer denials and enhanced cash flow.
Medical Coding and Charge Entry
Process: Translate healthcare services into accurate codes (ICD-10, CPT).
Automation: Implement AI-driven coding tools to reduce errors.
Outcome: Minimized claim rejections due to coding inaccuracies.
Claim Submission
Process: Ensure clean claims submission via an optimized billing system.
Tech: Use integrated Electronic Data Interchange (EDI) platforms.
Outcome: Faster reimbursements from payers.
Denial Management and Appeals
Process: Analyze, correct, and resubmit denied claims.
Action: Develop payer-specific templates to address recurring denial patterns.
Outcome: Higher revenue recovery rates.
Payment Posting and Reconciliation
Process: Accurately post payments and reconcile accounts.
Outcome: Clear visibility into outstanding balances and revenue trends.
Patient Collections and Follow-Ups
Process: Provide clear statements and set up patient payment plans.
Outcome: Enhanced patient satisfaction and improved cash flow.
Corporate-Level Services Provided by Krist Global Services:
Outsourced RCM Solutions: End-to-end revenue cycle management for healthcare providers.
Consultation Services: Workflow optimization and technology integration.
Custom RCM Solutions: customized to small, medium, and large healthcare practices.
