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Healthcare Revenue Cycle Management for better patient care

Article-Healthcare Revenue Cycle Management for better patient care

RCM ensures the patient receives the right service at the right time.

Healthcare providers strive to deliver quality patient care and improve customer satisfaction profitably, however, this is easier said than done. Today’s healthcare centres struggle with keeping operational costs down and thus it is vital to receive payments from patients and insurance companies in a timely manner to keep profits up. To accomplish this, the revenue cycle – or the life of a patient account from the time their case is opened until final payment is received – must be managed effectively, this is where Revenue Cycle Management (RCM) steps in.

Omnia Health spoke to Amit Agrawal, Senior Director of Operations, ACCUMED, about the importance of healthcare RCM and how it is directly impacting patients.

What is healthcare Revenue Cycle Management? 

RCM encompasses all administrative and clinical processes in a healthcare facility. RCM tracks patient care beginning with appointment scheduling, registration, appointment, insurance eligibility, and ends with the final payment for any given treatment. The goal of the RCM function is multi-fold and includes enhancing patient experience during the entire journey of clinical care, maximising claims reimbursement and revenue, improve cash flow and ensure regulatory compliance.

ACCUMED was the first company to provide specialist RCM solutions in the UAE and the GCC region at a time where the healthcare system in the UAE was embarking on transformation driven by the country’s visionary leadership.  We consider that every healthcare facility is unique, so we listen and understand their needs, and design custom solutions that are relevant, practical and scalable within the operating environment of the organisation. 

Why is RCM important?                                                                                                         

RCM has a critical role, not just in a healthcare organisation, but also at a macro level. At an organisation level, RCM directly impacts the financial performance of a healthcare organisation in many ways. 

From a strategic standpoint at individual hospital level, RCM function contributes to shaping the healthcare provider’s market segmentation and positioning which in turn determines the addressable market size and revenue generation opportunity. 

RCM deploys processes and technology to enable coordination, flow, and collation of essential administrative data across a complex eco-system comprising of front desk operators, physicians, labs, nurses, pharmacists, billing, collections and so on. 

This ensures the patient receives the right service at the right time, insurance and other healthcare payors receive accurate and timely information for their administrative purposes, and healthcare organisations bill and receive appropriate and timely remuneration. 

RCM helps in optimising revenue generation by ensuring the hospital prices its services appropriately and instilling proper process management of billing and collections from payors of healthcare services. Additionally, an effective RCM function aids in shortening the cash cycle thereby lowering the organisations’ cost of capital. 

Health insurance companies are beginning to see material efficiencies and savings in operational costs as RCM reduces the need to re-touch and re-work the same claim.
Lastly, RCM helps by providing insightful data and analysis allowing healthcare organisations to assess their financial performance, identify risks, make critical decisions, and take necessary corrective actions that aid right decision making. The data and insights are of importance not just at hospital level, but also at national healthcare system level as it enables stakeholders understand the healthcare needs of the population today and in future and ensure readiness to meet these needs.

How is RCM directly impacting patients?

RCM impacts patients by establishing what services the patient is eligible for in which healthcare facilities, providing timely information to payors, healthcare providers, and patients, so all parties are well informed about a patient’s condition thus providing uninterrupted healthcare treatment to the patients, and helping healthcare providers and insurance companies reduce their operational costs and therefore allows them to provide the finest healthcare services at optimised costs.

Effective RCM also aids hospitals to reduce rejection rates by insurance companies. It also helps reduce the cost of working capital by speeding up the cashflow. Lower operating costs empower healthcare operators to lower the cost of services for patients.

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