17 Apr

Revenue Cycle Management Ensures Systematic Hospital Claims Processing and Payment Collection

Doctor encoding the procedures done on a patientOne of the problems of implementing the Affordable Care Act is the information exchange between the various stakeholders. Principally, most hospitals have their own recordkeeping, which may be different from the databases and systems used by healthcare providers and health insurance companies. This may lead to waste and system loss.

Adequate hospital and health revenue cycle management is required for a stakeholder to provide accurate cross-platform assistance.

Integrated Approach Starting from the Source

In many hospitals and clinics, as well as other health and medical facilities, information gathering is a big issue. Correct information has to be encoded at the source. It can be the receiving area, the doctor’s office, or even the emergency room.

There are other sources of information, too, including the X-ray plates, laboratory results, ultrasound results, and more, which add information as the member uses the system.

Accessing the information in a format useful to the one requesting can be difficult. A revenue cycle management system may help standardize the information available to various parties.

Reimbursing Expenses

The healthcare model is different from other businesses. Services are not always paid immediately; instead, payables are accumulated and tabulated. Insurance and government-assisted healthcare reimbursements are, then, included. The documents for these deductions are sent to the proper authorities for collection and payment.

As that goes on, the remaining balance is sent to the patient or next of kin for payment. In most instances, the patient does not pay the hospital at the time he recovers. The bill is paid at a later date. Until such time that the patient settles these payables, the hospital or clinic “carries” the expenses in its books — like a non-liquid revenue, if there is such a term.

The delayed and distributed nature of hospital payment requires that the revenue cycle is kept up to date. The hospital has to ensure they are reimbursed for the room, services and any supplies used during the patient’s stay. The revenue cycle management system provides a way to keep track of the various amounts due from the patient.

This is not a trivial task, as there are instances when eligibility issues surface from claim denials. This has to be endorsed to the claimant for payment.

The revenue cycle management system is essential to a hospital or any healthcare facility. It ensures a streamlined method of filing claims and billing individual patients.