What is Revenue Cycle Management in Healthcare: Artificial Intelligence

Revenue cycle management refers to the financial process that healthcare facilities use to track patient care episodes from registration and appointment scheduling to final payment. The revenue cycle is an important part of any hospital or health system.

Revenue cycle management  in healthcare includes all of the activities that lead to payment for services provided, from patient registration to verification of benefits to care delivery, claim submission and reimbursement. It also involves communication—with patients, insurance companies, primary care, government payers such as Medicare and Medicaid.

Healthcare Revenue Cycle Management Basics

There are many steps that happen between making an appointment and collecting payment for services rendered. The healthcare revenue cycle management process can be broken down into three main stages:  patient care/registration, billing, and collections. Each stage plays an important role in ensuring that healthcare providers are paid for their services on time.

1) Patient care and registration – To ensure that patients receive quality care, providers must register new patients and track their demographic information, including insurance coverage.

Billing

Billing is the first step in the healthcare revenue cycle management process. It involves sending out bills to patients and getting them into a database so that they can be paid for their treatment. Patients will receive bills from doctors offices, hospitals, pharmacies and other medical facilities after receiving treatment from those organizations. Medical billing and coding are among the rest.

Collections

Collections are the second step in the healthcare revenue cycle management process. This involves contacting patients who have failed to pay their bills on time and getting them to pay what they owe before too much time has passed since they received treatment. There are several ways to collect from patients including sending out reminders, phone calls or even legal action if necessary

Health care is a multi-billion dollar industry that continues to grow. To keep pace with industry growth, healthcare organizations must have a clear understanding of their revenue cycle processes.

Revenue Cycle Management in Healthcare

Revenue cycle management (RCM) was once an internal concern of healthcare organizations. Because healthcare organizations have a hard time influencing external factors, such as patient payments and insurance reviews, it is difficult for them to influence provider productivity and patient fees.

Nowadays, revenue cycle management (RCM) has become an enterprise-wide process that addresses all the aspects of revenue generation and retention. To be successful at revenue cycle management (RCM), organizations must maintain a clear understanding of how different departments contribute to the overall health of their business.

For example, if a hospital's billing department is not working efficiently, it might cause patients to pay higher out-of-pocket costs. This can also lead to unnecessary litigation if patients feel they are owed refunds for services they never received or did not receive in full.

A hospital might also experience difficulties with its financial statements if it doesn’t have proper software systems that track expenses and revenue by department. Without this information, management cannot accurately predict future cash flow needs or evaluate employee performance against goals set forth by leadership teams.

How Artificial Intelligence Helps Drive Healthcare Revenue Cycle Management.

The value of AI in healthcare is clear. One of the most common uses of artificial intelligence is in predictive analytics, which allows organizations to make predictions about future events based on historical data. This can help identify patients who might need additional care or services and can also streamline the RCM process by automating many routine tasks.

Artificial intelligence can provide effective solutions to help address the most pressing revenue cycle management issues, charge capture, such as prior authorizations, denied claims, claim status checks, and out-of-pocket cost estimates.

Improve your performance and operational efficiency.

Healthcare operations today are a complex combination of deeply interconnected systems and processes. This makes it difficult to maximize cost while maximizing asset utilization, ensuring low wait times for patients, and maintaining high quality of care.

Health care providers are increasingly using artificial intelligence to analyze the huge amount of data within their digital ecosystems to gain insights that can help improve processes, drive productivity, and optimize performance.

Artificial Intelligence and Machine Learning can improve medical facilities' revenue cycle performance by optimizing workflows and automating tasks in medical facilities by prioritizing services for patients based on their acuity and resource availability, optimize revenue cycle performance.

Improving workflows such as prior authorizations and claims denials, and automate routine, repeatable tasks to better deploy human resources when and where they are most needed.

Why is revenue cycle management important in healthcare?

The process from initial delivery to full payment of hospital-based physician specialty revenue can be complex. It can take a long time for providers to get paid, and sometimes mistakes are made during this process.

Revenue cycle management is an essential part of healthcare operations. It ensures that your organization receives payments for services delivered and that it's able to pay for them. Long payment times are common in healthcare, but Revenue cycle management (RCM) can help reduce those delays by managing accounts receivable more efficiently.

Because effective Revenue cycle management (RCM) is essential for all health systems, each hospital service line implements an Revenue cycle management (RCM) process.

Which Revenue Cycle Management Automation Company Should I Use?

Jorie Healthcare Partners are committed to being a trusted partner by offering customized solutions that address each client's unique needs. Our team of healthcare industry experts has more than 30 years of experience helping providers improve their operations through a wide range of services including:

Jorie Healthcare Partners is a leading, independently owned healthcare practice management and consulting firm that exclusively serves hospitals, health systems, academic medical centers and physician practices using an integrated tailored approach. We help our clients improve their financial, operational and clinical performance across the organization to sustain long-term, measurable results. This system positions providers of all kinds to succeed in today’s challenging and rapidly changing revenue cycle regulations.

Jorie Bots – Jorie Bots are available right now, ready to be customized to your specific needs and revolutionize the way you manage your RCM. Call (888) 522-0022 or schedule a Jorie Bot demo today.

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