REVENUE CYCLE
MANAGEMENT
KNOWLEDGE CENTRE

Here are 7 proven strategies to accelerate your insurance reimbursement and inject some much-needed speed into your cash flow

Embracing automation is not just a technological upgrade; it's a practical transformation that revolutionizes the healthcare landscape. Picture a scenario where claims effortlessly glide through the system, avoiding the pitfalls of manual errors.

The patients arriving for care are the audience, eagerly anticipating a harmonious experience. In this symphony of healthcare, Revenue Cycle Management (RCM) takes the esteemed position of lead violin. Its melody dictates the rhythm of financial health, guiding every note from the gentle touch of patient care to the final flourish of payment collection.

AI has ushered in a new era of precision and efficiency. Machine learning algorithms analyze complex medical images, from X-rays to MRIs, identifying patterns and abnormalities with unprecedented accuracy.

AI has ushered in a new era of precision and efficiency. Machine learning algorithms analyze complex medical images, from X-rays to MRIs, identifying patterns and abnormalities with unprecedented accuracy.

Enter 2024, where finding and retaining skilled personnel feels like scaling Mount Everest in flip-flops. Fear not intrepid healthcare leaders!

As of 2024, statistics reveal a substantial surge in the adoption of automated solutions across healthcare organizations.

The symbiotic practices of medical billing and coding emerge as indispensable pillars, fostering the seamless integration of financial transactions with the intricacies of patient care documentation.

Among the sectors undergoing a profound metamorphosis is healthcare, where the influence of AI and ML is distinctly felt, particularly within financial systems.

According to a recent survey by Zendesk, a striking 87% of accomplished revenue cycle professionals credit their success to a commitment to ongoing learning. This compelling statistic emphasizes the direct link between...

In modern healthcare, the complex dance between pain management and the overarching financial intricacies within healthcare organizations is garnering increasing attention.

As patients navigate the labyrinth of deductibles, insurance nuances, and the weight of out-of-pocket costs, healthcare providers face the daunting task of efficiently collecting payments while preserving patient satisfaction.

Beyond being a mere chronicle, this analysis serves as a beacon, illuminating pathways for navigating the complex tides of change.

One area where automation has made a significant impact is in the pre-authorization (pre-auth) process. By combining automation with the human element...

The transition to ICD-11 is not merely a procedural shift; it represents a profound reshaping of practices, procedures, and overall outcomes within the expansive and crucial healthcare sector.

Accurate medical coding and timely medical billing play a pivotal role in healthcare documentation, impacting various aspects of the healthcare industry. The synergy between...

RCM companies bring a wealth of experience and knowledge to the table, acting as guiding forces through the labyrinth of financial transactions within the healthcare sector.

A well-crafted revenue integrity strategy serves as the cornerstone for optimizing revenue cycles, mitigating risks, and fostering a sustainable financial foundation.

The healthcare industry is undergoing an exemplary transformation, with organizations grappling to optimize their revenue cycles. In this pursuit, decision-makers are faced with a crucial choice: should they manage revenue cycles in-house or leverage the benefits of outsourcing?

The consequences of coding errors ripple through the entire revenue cycle, impacting not only the financial health of the organization but also the quality of care extended to patients.

In the implication of healthcare administration, outsourcing insurance eligibility verification stands as a pivotal process that can significantly impact the efficiency of claims processing. The accuracy and speed with which eligibility is verified can make or break the revenue cycle for healthcare providers.

It is not merely about explaining costs but empowering patients with the knowledge, resources, and strategies necessary to confidently manage their financial responsibilities throughout their healthcare journey.

According to recent industry reports by AMA, businesses that prioritize and adapt to these changes experience a 25% increase in revenue efficiency and a 20% reduction in operational costs.

According to recent study by Etactics, an estimated 80% of medical bills contain errors, and these discrepancies can significantly impede patients' ability to access timely and affordable healthcare.

Astonishingly, studies by Physician’s Practice reveal that approximately 80% of medical bills contain errors, leading to a cascade of denials, rejections, and financial setbacks for healthcare providers.

Recent data highlights its positive impact on the efficiency of medical practices. However, with this strategic move come challenges — from data security to technological integration and service quality.

As we navigate the landscape of healthcare tools, it becomes evident that the need for accuracy and streamlined processes has never been more crucial. From the intricacies of coding to the transformative power of cutting-edge technology...

While necessary to manage costs and ensure appropriate care, the prior authorization process has often been associated with administrative burdens, delays in patient care, and challenges for healthcare providers.

Navigating the intricate terrain of modern healthcare, providers are confronted with a persistent challenge that reverberates across the industry—claims denial management. A staggering statistic by KFF underscores the gravity of this issue...

In the world of healthcare, the burden of denials can weigh heavily on the financial health and operational efficiency of healthcare organizations. Denials occur when insurance claims...

Consider this fact: medical billing is not just a routine administrative task; it's the financial lifeblood that sustains every healthcare practice. As per ZipDo, a staggering 80% of healthcare revenue is dependent on effective and professional medical billing practices.

The increasing emphasis on value-based care and alternative payment models will require healthcare providers to shift their focus from fee-for-service to the delivery of high-quality, cost-effective care. This transition necessitates a more precise approach to coding, documentation, and claims submission, as denials may occur when services are not aligned with quality measures.

The ability to effectively navigate and address claim denials is pivotal in safeguarding financial stability, optimizing revenue cycles, and ultimately ensuring the seamless delivery of high-quality patient care. These elements represent crucial facets of the revenue management landscape where accuracy, compliance, and efficiency are paramount. 

Among the myriad responsibilities that fall under their purview, one stands out as both a challenge and an opportunity - denials management. It's a fact that revenue cycle leaders spend a substantial amount of their time addressing and preventing claim denials. This relentless dedication is driven by the fundamental recognition that the revenue cycle is the lifeblood of any healthcare institution.

Evaluating your practice's financial well-being is a pivotal step toward fostering future growth. By gaining insights into the metrics that influence your revenue cycle, you can proactively enhance your practice's efficiency and financial stability.

Claim denial is one of the most complex issues faced by healthcare organizations. Checking and re-submitting claims is taxing and time-consuming. Besides wasting the doctor’s and coding and billing staff’s time, it can be frustrating for the patient as well. “About 48.3 million rejected claims accounted for 16.6% of the total in-network claims submitted in 2021,” spilled out one research.

Denials are a significant roadblock in the revenue cycle, leading to delayed or lost reimbursement and increased administrative burdens. The ever-increasing complexity of billing and claims processing demands a proactive approach to denials management.

As the healthcare landscape undergoes continuous transformation, denials management has emerged as a linchpin in the financial stability of healthcare providers. In recent years, the volume and complexity of denials have grown, necessitating a proactive approach to prevent revenue leakage.

Managing revenue cycle costs has always been a critical concern for healthcare organizations. The revenue cycle encompasses a range of processes, from patient registration to claims processing and reimbursement.

In an era where patients demand convenience and accessibility, the successful medical practice of the future will leverage technology to provide a seamless and patient-centric experience.

Managing bills, insurance claims, and patient records can be a daunting task. In fact, healthcare organizations often process thousands of claims, leading to a high potential for errors and inefficiencies. The good news is that technology is coming to the rescue!

As the healthcare industry undergoes a profound metamorphosis, medical practices find themselves at the crossroads of innovation and adaptation. To thrive in this ever-changing environment, medical practices must not only adapt but...

Medical coding and billing are a complex but essential part of the healthcare industry. Accurate and timely coding and billing ensures that healthcare providers are reimbursed...

The revenue cycle, which involves the practice’s financial journey, plays a pivotal role in shaping overall patient experience. From the moment a patient registers to the final settlement of bills, each step influences the patient's perception of the healthcare accessibility.

At the heart of this intricate system are medical billing codes – alphanumeric symbols – that represent medical procedures, services, and diagnoses, which play a pivotal role in the submission of claims and reimbursement by insurance companies.

To ensure the effectiveness of RCM, it is essential to measure its performance accurately. But how do we accurately measure the performance of an RCM?

Denial management is a vital process addressing rejected insurance claims, crucial for financial stability and seamless patient care. Denied claims result from errors or incomplete data, necessitating a thorough understanding of their varied causes.

The increase in patients backed with insurance policies has resulted in medical healthcare providers – especially hospitals suffering a 25% loss in their revenue.

In the world of healthcare, where the aim is to make things run smoother and focus more on patient care, outsourcing medical coding and billing has become a regular thing for healthcare providers.

Ensuring patient access to the necessary therapies/treatments or practices involves managing various components, and while medical billing and coding play a crucial role, they often don't receive the attention they deserve.

A crucial metric, A/R days measure the average time it takes for healthcare providers to receive payment after delivering medical services.

In the complex world of healthcare billing, dealing with insurance claim denials is an ongoing challenge. Denials not only affect a healthcare provider's revenue but also lead to administrative headaches and delays in patient care.

As you are aware, A/R days represent the duration it will take for a healthcare provider to receive their payments from insurance companies for the services they provided. There are times when this waiting period stretches for a very long time.

While often seen as intertwined, they serve different roles in the healthcare ecosystem. Understanding the nuances and disparities between these two is essential for healthcare practitioners, administrators, and professionals aiming to navigate financial well-being effectively.

When it comes to navigating the complex world of healthcare, one term that often arises is “prior authorization” or “prior auth.” Although it may sound like an intricate process, fear not! In this comprehensive blog, we’ll delve into the depths of prior auth.

This term might sound complex, but it's essentially a patient’s first interaction with the healthcare system. Think of it as the front door to the world of healthcare.

The implementation of a streamlined denial management procedure will result in a noticeable decrease in claims being declined, resulting in grater warning potential for healthcare companies.

Effective revenue cycle management (RCM) is important for the financial fitness of healthcare companies.

The realm of medical coding & billing might appear as a labyrinth of codes and paperwork, but its significance reverberates far beyond administrative corridors.

Learn about interrelated nature between Patient Access Management and Revenue Cycle Management in healthcare, its importance, processes, and the revolutionary influence it has on the healthcare sector.

Learn about different coding methodologies, their unique purposes, and how they collectively contribute to the efficiency, accuracy, and success of the healthcare industry.

Efficient medical billing is crucial for maintaining a steady revenue stream, minimizing billing errors, and ensuring timely reimbursement.

Medical coding not only helps in identifying issues related to clinical documentation but also produces clear claims while generating revenue without compromising on quality.

Emerging trends hold the potential to reshape medical practices, improve patient outcomes, and enhance the overall efficiency and accessibility of healthcare services

The future of A/R management in healthcare holds promising trends that aim to address existing challenges and improve overall efficiency

As prior authorization in healthcare becomes increasingly prevalent in the healthcare industry, physicians must grapple with the added pressures and challenges it brings to their roles.

The revenue cycle management analytics analyses the complete lifecycle of revenue right from the patient’s first appointment at the clinic to the final payment and follow-ups.

Accurate and efficient medical billing is vital for optimizing revenue, reducing claim denials, and ensuring the financial viability of healthcare providers.

The cost of RCM services can vary depending on the size and complexity of the healthcare organization, as well as the level of service required.

Outsourcing medical billing & coding services can be a game-changer for your practice, allowing you to focus on patient care while leaving the billing and coding to the experts.

Outsourcing medical billing offers several compelling advantages that can significantly improve revenue cycles, streamline operations, and enhance overall practice performance.

Precertification, also known as prior authorization (PA) or pre auth, is the process of obtaining approval from insurance providers before certain healthcare services can be rendered.

In today's healthcare landscape, patient financial anxiety has become a pressing issue. The rising costs of medical procedures and treatments often leave patients worried about their ability to afford necessary care.

In the healthcare sector, these waivers allowed providers to offer telehealth services to patients without prior authorization, and reimbursements for telehealth visits were increased.

Medical billing service companies are third-party providers that specialize in managing medical billing and coding for healthcare providers.

Efficient management of accounts receivable (A/R) is an essential aspect of every healthcare practice. The effectiveness with which practices handle receivables has a direct impact on cash flow and, ultimately, financial health.

An effective A/R management ensures that the business receives payment for its services on time, reducing the risk of financial instability.

After the financial struggles many health systems faced in 2022 — with operating margins negative for 11 consecutive months according to Kaufman Hall — the revenue cycle is in the spotlight in 2023. Health system leaders are turning to their revenue cycle experts to shape their overall strategies. To navigate these challenging times and optimize financial performance, healthcare organizations are increasingly recognizing the critical role of revenue cycle management services. RCM services encompass a range of strategies, technologies, and processes aimed at maximizing revenue, improving cash flow, and enhancing operational efficiency throughout the revenue cycle.

The healthcare revenue cycle management (RCM) market was worth over USD 140 billion in 2022, and it is expected to grow at a CAGR of 12.5% from 2023 to 2032. This growth is primarily attributed to the increasing cumulative healthcare spending.

Medical billing denial is the biggest stumbling stone in the healthcare revenue cycle. As per Etactics, “In 2021, there were 48.3 million denied claims, accounting for 16.6% of all claims submitted that year.” There can be multiple reasons behind rising claim denials in a practice.

Do you find it difficult to track patient visits, code diagnosis, and treatment, and submit clean claims timely? Is it taking too long for the insurance company to reimburse the amount for the services rendered to the patients by your practice?

The healthcare industry has long been shrouded in secrecy when it comes to pricing. The lack of transparency in the pricing of treatment, durable medical equipment (DMEs), or other hospital item has strained patients for a long. But with increased…

Around 15% of people in the United States live in rural areas – mostly older adults, who have higher rates of chronic health problems such as high blood pressure and obesity, diabetes and musculoskeletal pain. They need adequate medical attention…

What is your biggest revenue cycle challenge? Is it Prior authorization? Rising claim denials? Staffing Issues? Higher accounts receivable (A/R)? As per the Medical Group Management Association's most recent MGMA Stat poll, of the 825 healthcare leaders surveyed, about 48%…

Excessive revenue leakage poses a severe risk for U.S. healthcare practices — presently, many already function on negative margins. A 2018 survey conducted by Fibroblast of C-suite executives in healthcare revealed an alarming rate with which hospitals lose money or…

American Academy of Pain Medicine stated that millions suffer from acute or chronic pain every year in the US, and the effects of pain exact a tremendous cost, billions of dollars, each year. As the population ages, these numbers are…

The US government enacted The Patient Protection and Affordable Care Act (ACA), a comprehensive health care reform law, in March 2010 to improve the coverage, delivery system and reduce health care costs. Yet there remained a gap between people with…

Healthcare is transforming right in front of our eyes. The last 12 months have rocked the industry to the core. The ways facilities engage with patients from treatment to payment processing are changing. Pain Management Clinics are at a bigger…

In 2023 it’s harder to find dedicated back-office staff that are willing to stay on for the long haul. The average tenure of back-office staff is lower than its ever been. The constant turnover forces facilites to look at other…

Did you know? Between Dec 2019-2021, the median change in hospital operation margins (without CARES) dropped by 14.7%, while labor expenses per adjusted discharge increased by 26.8%. (Jan 2022 National Hospital Flash Report) It’s difficult to retain staff since “The…

As per the Centers for Disease Control and Prevention (CDC), 6 in 10 adults in the US have a chronic disease. Leading drivers include excessive alcohol use, lack of physical activity, and poor nutrition. While people must quickly adopt healthy…

Physicians are under increased stress to provide timely care. They issue prior authorizations (PA) for treatment without fully assessing the patient’s condition. To address this problem, several states have passed pre-auth reform laws that require physicians to obtain a full…

Whether you belong to a multi-specialty group or run your private practice, it's not easy to maintain a strong revenue cycle. Equifax, a credit agency, recently highlighted in a report that healthcare providers lose $1300 on an average daily due to…