Making Sense of RCM

Many hospitals in the entire country tend to get stumped over accounting for their operations and the bottom line. In some respects, part of making situations better requires taking stock of processes such as revenue cycle management, or RCM.

What is revenue cycle management all about? Essentially, it’s the process by which hospitals ensure that they receive appropriate payments in a timely manner. The revenue cycle starts from data collection, i.e. when the patient sets an appointment, and ends when the patient’s balance zeroes out. Throughout the process, there is a need to balance patient satisfaction and the institution’s revenue and sustainability.

Since a majority of patients may be enrolled in an insurance policy, gathering accurate data and verifying information becomes top priorities. After patients provide insurance information, it is advisable to confirm eligibility for coverage prior to hospital admission. Through this practice, the hospital can avoid expensive liabilities and minimize the likelihood of claims being denied, which can cause undue inconvenience to patients.

As the EHR Intelligence excerpt suggests, using a certified EHR technology makes the process more efficient. The automated system can record insurance information aside from other health data, so the hospital can send batches of data to a clearinghouse for eligibility confirmation.