Seamless Transition to Revenue Cycle Management Automation

Moreover,  enhance your healthcare organization’s financial performance with expert revenue cycle management services, streamlining billing and collections. Learn more about our comprehensive revenue cycle management solutions and improve your bottom line. Discover the benefits of outsourcing revenue cycle management today!

Reasons For Transitioning To Revenue Cycle Management Automation

You initiate the revenue cycle management process immediately after providing healthcare services to your patients. It is completed once they or their insurance providers have appropriately reimbursed you for your medical procedures and treatments.

Many complex processes are involved in this, which severely require a complete overhaul. One solution is a complete transition to automated revenue cycle management practices. There can be various reasons as to why you should execute that transition.

1. Scheduling Appointments

Hospitals and clinics have to schedule a lot of appointments between their medical professionals and patients. It is a highly patient-centric and systematic process in which you must prioritize time for your deserving patients.

As a result, you may be required to schedule a high amount of appointments in a limited time. Such scenarios often result in troubling discrepancies and errors for patients. Automated appointment scheduling can prevent the loss of potential appointments and boost your RCM.

2. Verifying Insurance Eligibility

Insurance eligibility verification is another complex procedure in which you have to verify your patients’ insurance coverage and other details. This verification ensures that they are financially eligible to avail of your healthcare procedures and treatments.

Medical institutes have to go through various documents and execute multiple checks to complete their verification. These reasons can compel you to completely transition to RCM automation to save time and prove that your services will be reimbursed appropriately.

3. Establishing Patient Accounts

You also have to set up patient accounts in your healthcare organization. Hospitals and clinics often demand several pieces of information from their patients for this process. They have to efficiently store and maintain this large amount of records.

These records also undergo constant updates depending on the type of medical services provided to the relevant patients. Updating can become a daunting task if you are unable to effectively manage it. You can implement revenue cycle management automation for this.

4. Identifying Medical History

The medical history of your patients is an important aspect of their diagnoses. It is specifically documented as part of their records, with healthcare staff actively referring to it. You have to regularly check every aspect of medical history to determine possible health effects.

This process can also take up a lot of your valuable time that can be utilized elsewhere. Healthcare organizations can counter it through revenue cycle management automation and develop self-operating solutions.

5. Medical Coding

Medical coding is a clinical process in which you have to assign medical codes to your services. These codes are used to file reimbursement claims to be sent to insurers. You can integrate revenue cycle automation to prevent claim denials resulting from invalid coding.

A smooth flow of approved claims ensures that your medical institute constantly receives appropriate reimbursements. As a result, you can enable a stable cash flow, which simultaneously results in an optimized revenue cycle.

How To Transition To Revenue Cycle Management Automation?

There is a multifold approach to completely shifting your healthcare processes to automated revenue cycle management. It involves automated technologies that evaluate value-based medical transactions and changes in reimbursement policies.

These technologies utilize this evaluation to overhaul your processes and align them with automated revenue cycle management practices. They mostly include the merger of front and back-end RCM, performance tracking, optimizing collections, and many more practices.

1. Merging Front And Back-End RCM

Healthcare revenue cycles have specific front-end operations and back-end tasks. You must merge them whenever shifting towards revenue cycle management automation. Your front-end operations are more patient-oriented, with the back-end tasks mostly based on payments.

As a result, the merger is important since patient-related processes must be accurately linked with your payment matters. It develops a holistic, automated management plan that perfectly balances both sides and effectively completes revenue cycles.

You can receive faster reimbursements as automation enables you to monitor and follow up with any overdue payments. Hospitals and clinics can also predict future irregularities and errors before they submit their claims to insurance providers.

2. Revenue Performance Tracking

You can also implement data analysis to track your revenue performance as part of the transition to automation. It primarily involves a specific software that can monitor the performance metrics of your revenue cycle management.

The software also devises technical solutions in the form of necessary changes. You should swiftly incorporate these changes into your revenue system to prevent problems. Performance tracking is an effective practice as it provides insights to improve RCM.

This way, you can create a data-driven revenue cycle to efficiently manage your healthcare organization’s administrative and financial processes. Hospitals and clinics can integrate RCM automation to develop and oversee key performance indicators about their processes.

3. Optimizing Reimbursement Collections

Various collection features embedded in revenue cycle management automation enable medical institutes to increase patient financial responsibility. They can regularly follow up on their patients and provide new updates about their overdue payments.

You can utilize those features to optimize your reimbursement collections through regular payments. Features like payment reminders and automated bill creation can lead to those payments. You can reduce the additional staff needed for payment collections from patients.

The software also has some additional features that can be exercised to upscale your revenue cycle management. They comprise predictable financial estimates derived from your historical patient data and payment models like pre-service and point-of-service.

4. Prior Authorizations

In addition, hospitals and clinics can implement an automated tool to verify the insurance eligibility and prior authorizations of their patients. These operations are characterized as parts of claims management in which you handle specific matters of filing reimbursement claims.

This way, revenue cycle management automation can make your clinical processes more efficient through medical attention and data analysis. You can oversee the transition without any unnecessary delays and ensure complete implementation of the automation technologies.

5. Appointment Scheduling

Healthcare organizations can incorporate another practice into their revenue cycle management to solve their appointment scheduling problems. This practice is also based on automated software that electronically feeds insurance details and patient appointments into your system.

It also generates them for your record-keeping and ensures future usage. You can also utilize the software to check the insurance eligibility of your patients before they book appointments. This feature minimizes holding up patients and maintains a steady flow of patient visits.

Furthermore, healthcare organizations can also prevent claim denials as all insurance details of their patients are clarified. The insurance providers are also aware that those details have already been verified. Therefore, they accept claims and contribute to your revenue growth.

6. Medical Coding

Revenue cycle management automation also addresses the medical coding issues encountered during patient registration. You can electronically diagnose accurate codes to transition your medical coding operations towards automated technologies.

Electronic diagnosis reduces manual application and identification down to almost zero to minimize coding errors. This automation practice generates a report on missing charges as well. You can use that report to identify your coding gaps and conduct a cost-benefit analysis.

7. Electronic Reimbursement Claims

Electronic reimbursement claims are one of the key practices of revenue cycle management automation. Hospitals and clinics can now electronically file and submit their claims to the insurers as part of the transition.

It involves an enterprise solution with which you can manage the entire process through an entire revenue cycle. This way, you can address all your accounts receivables from one digital location and cover all bases, including reconciliation and registration.

8. Electronic Payment Posting

Furthermore, you can electronically manage your payment posting just like reimbursement claims. It saves up a considerable amount of time that your clinical and administrative staff can utilize on other important matters. One of them is providing quality care to your patients.

Although payment posting is a vital business procedure, it does not warrant manual intervention and is easily implemented electronically through automated solutions. 

You can also set up audit controls to ensure its smooth transition to revenue cycle management automation. This way, medical institutes can easily identify the reasons for insurance providers to deny their reimbursements.

Apart from that, discover essential tips for automating revenue cycle management in medical billing. Optimize efficiency and boost revenue with expert insights.

The Bottom Line

This blog assessed how hospitals and clinics can transition their healthcare processes toward revenue cycle management automation. We specifically explored the reasons for the growing need for this transition, along with some of its key practices.

Health Quest Billing has a dedicated team full of experts who have overseen several transitions of medical institutes toward revenue cycle automation. Contact us today to identify the best practices for you to automate your revenue cycle management services.