Revenue Cycle Management, shortened as RCM, is a process through which healthcare providers and hospitals recognize, validate, and collect bill payments from the patient’s insurance companies. Therefore, revenue Cycle Management (RCM) has become one of the key aspects of hospitals and other medical billing companies. Moreover, it is also a very complex and protracted process; hence, it is assigned to expert companies to outsource the medical bill payments.
So how does the RCM work? As mentioned earlier, the process is intricate and may involve a series of steps. Although these steps vary from company to company majority of revenue cycle management companies work as follows;
- First, the patient gets an appointment with the healthcare provider. Upon visiting the practitioner, he may discuss whether or not his medical insurance can cover the treatment.
- At the patient’s request, the practitioner will go through the patient’s insurance plan to check whether his treatment will be covered by the insurance plan or not.
- Once the patient has undergone the treatment, a detailed report is prepared based on the patient’s medical history, ailment, and treatment. The report is then forwarded to the medical biller who prepares the claim. He then checks whether the claim complies with the billing standards. Another thing that must not be overlooked is that all medical claims must be submitted electronically. It has been specified by the HIPAA (Health Insurance Portability and Accountability Act of 1996).
- The next step is highly crucial as the claimant will adjudicate the claim. He will verify how much amount can be utilized. A statement is prepared by the claimant, followed by the patient’s collection of the payable balance.
The entire process requires multiple follow-ups by the patient but vividly shows how the RCM companies work. So here is what you need to look for in a top revenue cycle management company;
Experience of The Company:
When looking for a company with top revenue cycle management technology, you should always compare the age of different companies. The older the company, the more reliable it will be. At least the company must have an experience of five years to compete with its other counterparts in the market.
ISO 9001 Certification:
Another common yet effective way to narrow down the options is to check for ISO 9001 certification. The ISO 9001 certification is given to ensure that a particular process fulfills the desired quality standards.
The Clientele of The RCM Company:
One of the mainstream criteria for shortlisting the revenue cycle management company is to go through their list of clients. The quantity and type of clients the company serves play a major role in picking out a reliable and experienced RCM company.
HIPAA Standards:
HIPAA was formulated to establish standards that each company would follow to safeguard the personal data of the patient. As it is of paramount importance to the patient’s point of view, you should always check the level of compliance of the RCM companies to the HIPAA standards.
Use the above factors when looking for a top revenue cycle management company.