Ask 100 people what revenue cycle management means, and you’re likely to get 100 different responses.
For the purposes of this article, let’s begin with the definition according to the Healthcare Financial Management Association. They define revenue cycle management as “all administrative and clinical functions that contribute to the capture, management and collection of patient service revenue.” Further, the revenue cycle begins when the patient calls your office for an appointment and ends when their account balance is zero.
Do you agree, or is it different in your business? And why does it matter how you define it? According to a new report on revenue cycle management from CapSite, some 21 percent of U.S. hospitals are dissatisfied with their revenue cycle management system, and plan to replace it in the next two years. Increasingly, we see a lot of companies rushing to offer “revenue cycle management solutions” that may not fit the bill, especially if you don’t share the same definition of success.
If you’re shopping for a new service or are just trying to ascertain that you’re getting the most of the one you have, it’s important to start by defining the problems you expect a good solution to solve.
Begin by defining the scope of the revenue cycle in your operation, and compare your solution(s) against it by asking some basic questions.
Does your solution cover your functional needs?
- Eligibility and benefits verification
- Charge capture, entry, and coding
- Claims scrubbing, submission and edit and error management, including submission of secondary claims
- Remittance management, including handling paper remittances
- Payment and denial management
- Insurance follow up
- Patient statements and collections
- Reporting and analytics
- Training, service, and support at the level you need
How does your solution measure up against other criteria that affect your overall success?
- Does your solution provider act as a partner, and not just a vendor?
- Is it easy to implement and/or does it integrate with your other key systems?
- Do you get the level of onsite support you need?
- Is there a clear and simple pricing structure?
- Does it provide good value for the cost?
- Does it make your job easier?
The final question
Having better-defined your expectations of a revenue cycle management solution, you’re in a better position to answer the final question: Is your current (or chosen) solution capable of delivering on the promise of improved financial performance?
The best revenue cycle management systems will provide you with a variety of automation tools, so you can perform fewer tasks manually, further increasing your efficiency. But at the end of the month, it is all about collecting payment at the lowest cost and the highest speed. So whatever revenue cycle management system you decide on, make sure it delivers on the end game – bringing your patient account balances to zero.