Do you own a healthcare business or startup? Then, you must be aware of the term revenue cycle optimization. This is a very common term used in every kind of healthcare. This mainly refers to the process of ensuring the financial stability of a healthcare system. From documentation to final payment process, this is a very long procedure.

In this blog we will discuss about what revenue cycle optimization is, how to improve it, and how a medical billing company can help us.The U.S. revenue cycle management market size was worth USD 64.13 billion in 2022 and is expected to grow at a CAGR of 10.7% during the forecast period. These stats indicate that as the market is growing, you need to focus more and more on the revenue cycle if you want to beat your competitors.

Getting a revenue cycle management company is the best decision you can ever make for your business. Dilijent Systems is one of the best medical billing and coding companies in the USA. We take care of your revenue cycle efficiently so you can get your rightful compensation on time. Join hands with Dilijent Systems and start the journey of success. 

Understanding Revenue Cycle Management (RCM)

If you want to understand what is revenue cycle optimization, you need to understand revenue cycle management. Revenue cycle is a process in healthcare that focuses on getting the compensation from insurance companies. This compensation is for the services that your provided.

Here are the main steps in revenue cycle management:

Patient Scheduling and Registration: It is the first step in the RCM cycle. In this step, you gather all the information about the patient. From general information such as name and address to medical information such as diagnosis, treatment, and prescription, you note it all.

Insurance Verification: After this, you collect information about the insurance of patient. You check whether the treatment required is covered by the patient’s insurance or not. This is a very crucial step as it helps prevent further complications.

If the patient’s insurance does not cover anything, you need to tell them immediately.  

Medical Coding: The next step is to convert all the data into medical codes. Medical codes are special set of codes that is designated by the American Medical Association. These codes are specific for each medical term.

This is considered the most crucial step because all the compensation depends on medical coding. The slightest mistake in medical coding can lead to claim rejection by insurance companies.

Claim Sumbission: Next you submit a claim to the respective insurance company. The insurance company then evaluates the claim and sees if there’s anything wrong. If they detect any mishap or mistake in the claim, it gets rejected.

Payment Processing: However, if your claim is correct, the insurance company accepts it and sends the compensation to the rightful owner.

Denial Management: Denial management is a very important part of this process because a lot of claims get rejected. Rejected claims cannot be ignored because they hold significant value. Otherwise, you need to carefully review the claim and submit it again to get it accepted. 

The above are the main steps involved in revenue cycle management. 

Best Strategies for Revenue Cycle Optimization

Now, after you have understood what the revenue cycle is, you need to understand how you can make it most effective and interactive. Revenue cycle optimization can be easily done by following these steps. These steps will ensure that your revenue cycle is at its best.

Improve Front-End Processes

The basis of the revenue cycle starts at the front end. Front end means all the processes involved in documentation and information gathering of the patient. You need to compute all the information correctly and efficiently to reduce any mistakes. 

The slightest mistake in this documentation process will lead to claim rejection. This problem can be solved by following some steps. For instance, always double check the information with the patients. Then, confirm all the medical information with doctors an paramedic staff to ensure every thing is correct. 

Enhance Medical Coding and Documentation

Medical coding is the basis of revenue cycle optimization, and you need to hire professionals for this purpose. Medical coders use special code sets such as ICD-10, ICP, and HCPCS. These coding techniques have special rules that you need to follow.

Other than this, medical coding rules are ever changing, so you need to train your staff accordingly. If you fail to comply with any of the rules, this is disrupt the process. 

Efficient Claims Management

Claim management also holds a lot of importance. In this, you need to take care about which claims are submitted, which are waitlisted, and which are denied. The claims should be submitted just once because double submission results in a fraud case.

If your claim has been denied or rejected, you need to see what went wrong. Then you need to correct that mistake and resubmit the claim accordingly. 

Implement Automation & AI in RCM

AI and ML are rapidly changing every field. Medical coding now includes a lot of AI software that can make the work easy for you. This software can code more effectively than humans with much less error. These AI software can also detect any mistakes made by humans in their code.

Insurance companies rely on codes made by AI because they have many fewer errors and mistakes. By opting for AI software, you can make your work much easier and efficient. This will also result in fewer claim rejections. 

Boost the Collection of Payments

Healthcare providers' financial stability is ensured by a simplified payment collection procedure. Patients find it easier to make payments when there are several options available, such as online, credit/debit card, and installment plans. 

Payment delays are reduced when patients are informed about their financial obligations prior to treatment. Reminders for automated payments increase collection rates and lower outstanding balances.

Examining Revenue Cycle Information

Monitoring key performance indicators (KPIs) aids in the decision-making process for healthcare professionals. Tracking Days in Accounts Receivable (A/R) facilitates tracking how quickly payments are made. 

By evaluating the Claim Denial Rate, one can spot rejection trends and implement remedial actions. The effectiveness of the revenue cycle is assessed by calculating the net collection rate. Financial decision-making is aided by real-time revenue cycle reports from business intelligence tools.

How a Medical Billing Company Can Help In Revenue Cycle Optimization?

All the above points seem to be too much for any healthcare practitioner. This is because you need to hire medical coders and separate administrative staff to do all the chores. Sometimes, you also need to train the staff to keep them updated about latest trends.

Other than this, you might also have to buy special software for medical billing that will make the process more expensive. 

This is where a medical billing company comes into view. A medical billing company can help in revenue cycle optimization. This means that another company can do all the chores for your business so you don’t have to worry about anything.

One of the best medical billing and coding companies in the USA is Dilijent Systems. Diligent Systems is an expert in various RCM tasks such as medical billing, medical coding, and medical audits. You can choose the best service according to your needs. Their cost is relatively reasonable than other companies.

Here are some factors that will make you consider outsourcing a medical billing company:

Expertise in Claims Processing

Medical billing companies have professionals who have been doing the task for many years. They are highly trained and skilled. These professionals can easily handle all the medical billing and medical coding tasks for you. 

If you are worried about hiring an inexperienced medical coder, you should go for a medical billing company such as Dilijent Systems. 

Cost Reduction and Revenue Improvement

By outsourcing billing duties, healthcare providers can improve revenue collection and cut administrative expenses. Software, training, and staffing costs are greatly decreased when an internal billing department is no longer required. 

Medical billing businesses also prioritize revenue recovery, which lowers the number of unpaid claims and boosts financial effectiveness.

Risk management and regulatory compliance

Medical billing firms reduce the risk of fraud, fines, and legal problems by ensuring adherence to the most recent healthcare regulations. They lower liability risks for healthcare providers by ensuring accurate coding and billing, monitoring regulatory updates, and putting in place HIPAA-compliant procedures for patient data security.

Revenue Cycle Management Driven by Technology

A medical billing business improves revenue cycle management by utilizing the newest technology. Predictive analytics and claims processing are streamlined by AI-powered solutions. Automation expedites payments and lowers human error. Decision-making skills are enhanced by real-time access to financial data offered by cloud-based RCM solutions.

Summary

For healthcare organizations to preserve their financial stability and raise patient satisfaction, revenue cycle optimization is crucial. Revenue cycle optimization is improved by putting best practices like automation, precise coding, effective claims management, and compliance monitoring into practice.

By lowering errors, boosting reimbursements, and guaranteeing regulatory compliance, a medical billing company plays a critical role in optimizing the revenue cycle. Healthcare providers can improve financial results and concentrate on patient care by outsourcing RCM services.

Outsource to the best medical billing company for your healthcare practice. Dilijent Systems stands out as one of the best medical billing companies in the USA. We provide top-notch services at a very affordable price that will fit your budget.

FAQS

What is revenue cycle optimization?

Revenue cycle optimization is the process of making the revenue cycle more efficient and effective. This process contains specific steps from documentation to payment processing.

What are the 7 steps of the revenue cycle?

There are 7 main steps in the revenue cycle. The main steps are: preregistration, registration, charge capture, claim submission, remittance processing, insurance follow-up, and patient collections

What are KPIs for revenue cycle management?

KPIs for revenue cycle are quantifiable measures that determine the financial strength of a business. For instance, total revenue, total net income, and profit, etc.