When a patient has a medical problem they schedule an appointment, check in with their insurance information, fill out a couple of forms, visit with the doctor, and go on their way with treatment in hand. The average person would think this is the end of it. However, the process is a lot longer and more involved for healthcare providers. The revenue cycle management (RCM) process starts when the patient first makes their appointment and continues well after they leave the healthcare facility. This process can take months.
What is Healthcare Revenue Cycle Management?
The RCM is essentially the billing process and includes managing patient accounts and receivables. The United States healthcare system depends on this system to track the billing life cycle of each patient. It monitors revenue from patients and unpaid balances.
Revenue Cycle Management Steps
- Charge Capture– Record patient history, care, and services in the medical claims system to bill the patient’s insurance.
- Coding– A Specialist applies medical codes to the patient record to determine the reimbursement amount.
- Claims Submission– Healthcare providers submit a claim and request payment.
- Insurer Communications– The billing manager must communicate with insurers to determine coverage and reimbursements.
- Payment Collections– The insurer pays for care covered by the insurance policy. The hospital bills the patient for the remaining balance. SWR can help patients understand charges and set up payment plans.
Southwest Recovery RCM Solutions
Our collection agents have the training and software to handle essential administrative tasks like medical billing and claims. Administrative errors can leave medical bill claims in limbo for an extended period of time. It can also cause the hospital to lose out on millions. Inattention to billing could also leave patients with huge bills that they can’t pay, that should’ve been covered by their insurance policy. Also, when hospital staff isn’t trained to bill correctly and they might not record relevant patient data or they may capture it incorrectly. It’s smart to outsource RCM work to a collection agency like SWR to cut down on mistakes and financial losses.
The claims process also needs to be monitored until its life cycle is complete. Each step needs to be completed correctly in order to get paid. This means registration needs to be done right, all services need to be documented, patient files need to be complete and comprehensive, and if a claim is denied by the insurance company it needs to be followed up on right away. Outsourcing RCM can help your medical practice manage payments and claims. SWR is efficient and can maximize revenue and increase the hospital’s profit.
Early Out Program
Southwest Recovery Services offers a special Early Out Program to help healthcare providers recover outstanding balances quickly. This program is incredibly efficient at recovering medical debt because we:
- Establish a relationship with the patient
- Determine barriers to repayment
- Establish a feasible payment plan
- Coordinate with insurance companies
- Monitor pre-authorizations and payment status
This program is beneficial for both the healthcare provider and the patient. It can even be adjusted to fit your practices’ needs. Give us a call or visit our website to learn more about how we can assist you with RCM and medical debt collection.