Today’s volatile healthcare environment is straining the revenue cycles more than ever before. Denials and bad debt are rising due to new levels of regulation and increasing patient responsibility for payment. Payer contract negotiations include new challenges tied to quality and outcomes. The transition to ICD-10 may severely stress your revenue cycle. Alternative payment models are now a business imperative.
An effective revenue cycle program must encompass much more than billing and collections; it needs to include coding, contract negotiation, physician engagement, quality and the entire patient experience and continuum of care.
Revenue cycle management (RCM) is the process that manages claims processing, payment and revenue generation. It entails using technology to keep track of the claims process at every point of its life, so the healthcare provider doing the billing can follow the process and address any issues, allowing for a steady stream of revenue.
The process includes keeping track of claims in the system, making sure payments are collected and addressing denied claims, which can cause up to 90 percent of missed revenue opportunity.
RCM encompasses everything from determining patient insurance eligibility and collecting co-pays to properly coding claims using ICD-10. Time management and efficiency play large elements in RCM, and a physician’s or hospital’s choice of an EMR can be largely centered around how their RCM is implemented.
Centric Healthcare Services’ revenue cycle solutions extend the capabilities of your information systems to improve access management, accelerate cash collection and improve payor performance.