Laboratories, pathology practices, molecular diagnostics, outreach programs and remote patient monitoring organizations all have financial pressures. Whether it is a competitive landscape, lower reimbursement rates, changing payor policies, fee schedule changes or rising denials and appeals, it's more important than ever to have a robust billing system that maximizes your revenue. Without it, you risk harm to your bottom-line.
What Is Revenue Cycle Management?
Revenue cycle management (RCM) is a process that uses software and other technology, such as artificial intelligence (AI), to track a healthcare organization's end-to-end billing and claims processing to improve cash flow and have visibility and control over financial operations. RCM also provides connectivity within and beyond the organization so that the billing process is thorough, expansive, and seamless.
With financial challenges and a move toward value-based reimbursement, providers are rethinking the way they approach RCM. Your RCM must meet today's complex needs. A robust RCM system should optimize billing and accounts receivable processes, automate as much of the workflow as possible, facilitate claim and appeal filing, and reduce regulatory compliance risk — all with the end goal of maximizing profits.
Substandard billing practices threaten both provider bottom lines and the ability to provide the highest quality of care. Therefore, the goal should be an RCM system that is transformative for your business.
RCM Factors You Should Know
The revenue cycle can be long and complicated. And because many steps separate the patient's first interaction with the provider and collecting payment for the visit, the traditional billing process has a myriad of risks caused by human error and clerical decisions.
Externally, many factors can interfere with your billing process and hinder timely payments, significantly as healthcare regulations and reimbursement models change.
If your billing system can't keep up with changing healthcare regulations and reimbursement models, you will find yourself demanding more of your staff or adding more personnel to your bottom line. Before that happens, develop a focus on improving efficiencies. If you don't, you might encounter situations that can upset your RCM process. Here's how traditional billing systems can affect your company:
- As healthcare costs grow and patients become more responsible for a larger cut, collecting their share becomes more challenging.
- Not connecting your front- and back-end offices to communicate with each other can result in claim denials. Your RCM should improve communications, which can aid in claims reimbursement, payment collections, and payor coordination.
- After claims are submitted, ongoing claim management is need to avoid missing, rejected, or denied claims. Your RCM should be able to reach beyond your own company and communicate with payors.
- Paper documentation can be lost. The digital workflow is critical to connecting internally and externally and eliminating the need for paper documentation.
Outsourcing Your RCM
Instead of developing a team to run their RCM internally, many providers are outsourcing this important program. According to a 2019 survey of managers, 90% of hospital leaders are evaluating whether to work with third-party vendors for cost efficiencies in both clinical and non-clinical functions. Diagnostic providers who outsource their RCM to XIFIN improve their cash collections on average by 20% to 40%. Here are some outsourcing benefits:
What to Look for in an RCM System
Whether you decide to set up an in-house team or outsource your RCM, make sure you're getting the following benefits:
XIFIN RPM 12 – Transforming RCM for a Changed World
Maximizing your revenue means submitting clean claims to payors and tracking them through reimbursement as quickly as possible. Without an advanced, transformative SaaS-based RCM solution, your traditional billing system can become outdated. And that's unhealthy for your bottom line.
XIFIN RPM 12 is a comprehensive, award-winning accounts receivable and financial management solution for diagnostic providers. It transforms how you manage your business by automating the end-to-end revenue cycle management (RCM) process and providing actionable insights through robust advanced analytics solutions.
The platform maximizes reimbursements and cash collections by offering robust workflow automation, enhanced patient and client portals, and additional business intelligence solutions, such as AI-enabled advanced analytics.
Along with a flexible billing model that lets you choose to take your RCM in-house or outsource your billing, XIFIN RCM comes with enhanced portal capabilities for your business success.
- XIFIN RPM 12 Client Portal — Improve engagement with referring physicians by providing easy-to-use order entry, ability to review statements at the line item level, access to testing information and prices, and much more.
- XIFIN RPM Patient Portal— Improve the patient experience by offering the ability to access and update existing account information, view statements, make payments anytime, and much more.
Read more about how a robust RCM solution can improve your organization’s total cost of billing in this white paper.