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Benefits Of Healthcare Revenue Cycle Management For Medical Practices

Revenue Cycle Management

Revenue Cycle Management (RCM) is described as the administration of financial transactions such as billing, collections, payer contracting, provider enrollment, coding, data analytics, and compliance when a medical provider, supplier or facility come across a patient.1

Difference between Medical Billing and RCM

RCM acts as a main pillar while managing a healthcare institution. Even though RCM includes medical billing components but it has a broad horizon beyond payment posting. RCM has more processes and provides more information compared to only medical billing. RCM is also used for successful management of the status of patient claims on their accounts receivables in medical practice. 2

Claims Management and Rejection

Effective claims management requires a comprehensive understanding of negotiating skills for payer contracts. Moreover, acquaintance with proprietary norms of each insurance company, knowledge of correct coding and timely filing methods, familiarity in refiling rejected claims, and knowledge of implementation of best practices for tracking and monitoring like charge capture audits and benchmarking are also important in reducing claims rejection. 3

A claims rejection rate of 10% on first-pass with a higher rejection rate for more complex patient visits has been reported even when the billing functions are well-designed. With a refiling cost of up to $25/claim or even higher, claims settlement might pose an expensive plan. Therefore optimization of the claims submission machine might aid in the better first-pass payment rate and the shorter billing cycles. 3

Health IT and Electronic Health Records (EHR): Driving forces for healthcare RCM

Health IT and EHR systems have facilitated to update with more accuracy to healthcare RCM strategies. Now several organizations thrive on technology-based platforms such as EHR to monitor claim related processes (track claims throughout their lifecycles, payment collection, and deal with claim rejections). Eventually, these technologies allow a consistent revenue generation.

The automation of common issues with healthcare RCM can provide many benefits to the providers. These include better payer-provider communications, proposing appropriate ICD-10 codes, tracking medical billing processes, and scheduling patient appointments.4

RCM services at GeeseMed

With the premium medical billing services of GeesMed, collection rates will considerably increase. The processing costs are reduced by as much as 60% with GeeseMed RCM services. GeeseMed RCM services enable both electronic claims and paper claims to over 1500 payers across the United States. A team of certified medical billing experts who focus only on billing and bill accurately, thereby reducing the rejected claims rate to 1%-2% and not 20%. 5

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