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Automation In RCM


Automation In RCM

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What is RCM ?

RCM i.e. Revenue Cycle Management is a financial process of identifying, collecting and managing  revenue from payers on the basis of services provided to them.

It begins when a patient makes an appointment and ends up with making a payment successfully. There are many steps in between this process and so every stem must be completed accurately and efficiently to ensure timely payment.

However, the frequently changing regulations laid by the healthcare ministry is making receiving timely reimbursement a challenging process. This is increasing demands on staff time and requires appropriate technology to complete its tasks.

Why Automation Is Needed In RCM ?

Automation is needed in revenue cycle management as the RCM cycle is initiated at the time of impairment of medical services to the patient and it is considered complete only when all the relevant claims and payments are being made. This is a very complex process, hence automation is necessary in RCM. In automation the following factors should be there :

  • Insurance Eligibility Verification : It is required from each and every patient and after acquiring it is verified with the help of relative protocol.
  • Scheduling Of Appointments : It involves taking appointment requests from the customers and then scheduling according to the time priority of the patients.
  •  Establishment Of Patient’s Account : It opens the patient’s account in the organization and also updates the account according to the services utilized.
  • Identification Of Medical History : Ib this, all the medical history of the patient is being identified and studied about the factors that may or may not affect the health of the customer.
  • Insurance Coverages : It identifies about the insurances and about the claims that were done in the past.
  • Claims History : It analyses the patient’s claim history and identifies which claims were rejected and which were selected.
  • Medical Billing : It creates the medical bills for the services that are offered to the customer.
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Challenges Faced In RCM :

There are some challenges faced in healthcare revenue cycle management. As it is a vast process, it is very difficult to maintain consistent profit throughout the year. The constantly evolving nature of the health industry is also a major problem as with all these changes it is difficult to maintain financial stability. Some other challenges in RCM are :

  • In maintaining financial stability.
  • Reimbursement of claims.
  • Communication between patient and claim agency.
  • Claims rejection as well as returns.
  • Identification of proper and accurate ICD – 10  codes.
  • Identification of insurance eligibility.
  • Tech and administrative problems.
  • Some patients use fraudulent means for claim submission.
  • Staff required for RCM management. 
  • Evolution of healthcare regulations.
  • Payment collection during and before the services are being rendered.

Automation helps in many ways :

  1. Patient Scheduling : In this process appointments are made for the patients in the initial stage while keeping patients as the major priority.
  2. Pre-registration :  It is an automated process where an account is being created with the help of data and information like medical history, insurance coverage, etc.
  3. Automatic Billing Process : In this step, invoices are created with the help of basic data entries. Claims are being identified, verification is made, and claims are being submitted in an efficient manner.
  4. Decrease in claim rejection and claim return : Rejections of claims is reduced with the help of automation as it identifies loopholes and human errors.
  5. Submission Of Claims : There is a special code known as ICD-10 code. It is automatically identified with the help of simple information that is entered and with the help this claim submission becomes much faster.
  6. Optimization of back end processes : After the claims are submitted, some back end processes like payment posting, collection of claims, denials gandled, etc are handled with the help of an automated software.
  7. Quick Turnaround : It naturally translates into faster receivables with the bills paid and claims approved.
  8. Reduction of costs : Administrative costs are reduced with the help of automation process and it saves a lot of time as well as money of the organization.
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Conclusion :

So hence, we can conclude that automation is needed in revenue cycle management as many organizations think that this process is very tedious which is not a very good thing and can cause adverse effects.

So, as we have discussed how automation helps in the revenue cycle management, we can say that it will benefit both patients and the organizations and so it must be applied to save money and reduce claims rejection.

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