Why Revenue Cycle Management Matters

Many people may overlook the fact that healthcare providers are also business owners. They must keep track of business tasks like billing and maintaining a profit on top of their medical duties. Revenue cycle management consulting offered through Physician Practice Specialists allows healthcare providers to keep their focus on providing quality patient care. Here are a few reasons why revenue cycle management (RCM) matters: 

Relieving the Administrative Burden 

A revenue cycle management partner offers comprehensive oversight of the non-clinical processes associated with patient care. They bring knowledge about practices related to patient registration, insurance pre-authorization, medical coding and billing, claim submission, and contesting denials. This expertise helps with the hard work already done by administrators and clinic managers. 

RCM also recognizes the importance of effective back-end processes. This extends beyond traditional care and claims processes to data collection and analysis. Over time, access to that information highlights areas where there may be opportunities for improvement. These can come from closing service gaps, implementing new technologies to help automate processes, and identifying potential new revenue streams. 

Improving Overall Financial Health 

Data shared from the National Library of Medicine shows that as of 2023, 25% of all non-profit hospitals in the US were operating under negative margins. An often overlooked aspect of healthcare is the need for hospitals and clinics to meet overhead costs. Revenue cycle management services help meet these costs through improved coding, documentation, and effective claims management. 

An RCM consulting firm offers the expertise to make sure clinical documentation supports the services provided and that medical coders are coding up to the level of service rendered. Claims management consultants make sure that accounts for professional and technical services are submitted within timely filing requirements. They also monitor appeals if and when denials occur. This helps guarantee that the maximum amount of available reimbursement comes back to providers and facilities as quickly as possible. 

Maintaining Regulatory Compliance 

With regulations changing often, healthcare providers need to stay current with new standards. RCM consulting services offer insight into new regulations that can help avoid penalties and even open up potential incentive payments. They can also help make sure providers and facilities continue to meet licensing and accrediting standards.

Having a revenue cycle management consultant may also serve as proactive protection against accusations of fraud and abuse. Your RCM consultant can offer an external auditor’s perspective and can advise when coding and billing practices may venture into gray areas. Access to such insight can help address potential issues before they turn into actual problems. 

Revenue Cycle Management Consulting You Can Trust 

Effective revenue cycle management helps to make sure that patients remain at the center of all healthcare services. Improved operational efficiency combined with stringent regulatory compliance offers incentives that can be passed on to their patients. New and improved resources through revenue savings and increased reimbursement contribute to better patient outcomes. Such benefits can directly result from choosing Physician Practice Specialists for your revenue cycle management consulting. Contact us today to learn more about our comprehensive suite of RCM services.