The transition from fee-for-service to value-based care payment in the healthcare industry has an impact on various facets of traditional RCM (Revenue Cycle Management). Read the blog to know in detail about the benefits of RCM in healthcare.

1. The Importance of Healthcare
Revenue Cycle Management
The transition from fee-for-service to value-based care payment in the healthcare industry
has an impact on various facets of traditional RCM (Revenue Cycle Management).
Healthcare providers, whether they are major organisations or individual practitioners, need
strong or expanding financial bases to continue providing their services without interruption.
The top medical billing and coding service is here to assist you.
Medical "Revenue Cycle Management" encompasses a wide range of administrative and
clinical tasks, such as patient eligibility determination, claims processing, payment, denied
claims management, and revenue generation.
RCM is extremely important to healthcare organisations because it streamlines processes
like bill payment and resource management. According to a survey by an international
standards agency, healthcare providers lose a significant amount of money every year since
more than 25% of medical claims are rejected and up to 40% of those claims are never
resubmitted.

2. Fortunately, an efficient RCM process has the potential to reduce the amount of bad debt
written off while maximising the benefits to the healthcare industry. The practice of medical
billing serves as a basis for the difficult challenge of healthcare software development.
The Basics of Healthcare RCM
● The process starts when a patient requests medical services and concludes when
payment in full has been made to the healthcare providers.
● The first administrative responsibilities done by the health group personnel include
scheduling appointments, checking insurance coverage, and setting up patient
accounts.
● Claims submission begins once treatment is finished. Professionally coded claims
have the proper ICD-10 codes, which establish payment amounts and, if the code is
authorised, prevent claims rejections.
● The question of who will make the actual payment, a private corporation or a
government body, then arises. They assess the validity of the claims, verify the
supporting documentation (such as insurance policies, contracts, etc.), and finally
submit the claims for payment.
● For the most part, claims are denied due to clerical errors, inaccurate coding, or
missing patient information.
● Maximum reimbursement for submitted claims is the holy grail of revenue cycle
management. RCM helps medical facilities and doctors by decreasing the frequency
and duration of claim denials.
● After that, healthcare providers or individual veterans implement AR. They then
follow up by submitting healthcare claims to insurers either manually or electronically.
● When a patient pays their bill , their information (name, account number, denial
information, treatment dates, etc.) is recorded in a phase of medical practice
management software called "Payment Posting."
Relation to Health Care:
It can help healthcare organisations better monitor their financial progress. Depending on the
RCM method used, it could be easy to observe what proportion of claims are approved
versus denied. By refining their RCM processes, healthcare organisations improved their
medical billing process management and responded quickly to patient complaints about
claim denials.