A Comprehensive Guide to Evaluating Your Revenue Cycle 

Despite the fact that healthcare practices are extremely useful, they are ultimately a business. This implies that they must generate income in order to keep providing patient care. Revenue cycle management is a process that providers must become proficient in order to guarantee they are compensated for their services and that their practices may remain open. Postponing or refusing insurance claim payouts is nothing new for healthcare organisations. It is estimated that approximately 25% of refused claims are never paid at all, therefore practices that deal with this issue run the risk of experiencing year-round revenue losses.

In order for your clinic to continue treating customers and making money, it is imperative that you confront and solve the issue of extraordinarily high rejection rates. Examining and analysing your practice’s revenue cycle is one of the best ways to find ways to prevent such rejections. Let’s examine how to carry out this kind of assessment and how the appropriate medical billing solutions will help you maximise your revenue cycle for practice expansion.

What Is Revenue Cycle Management?

Healthcare providers use revenue cycle management (RCM) to track and collect payments from insurance companies, patients, and other payers. From confirming insurance coverage to collecting payments and monitoring unpaid balances, RCM covers every stage of a patient account’s lifecycle.

One of the most important things a firm should think about is revenue. After all, if an establishment is losing money while spending it, how long can it continue to operate? To ascertain their finances and returns, several organisations have revenue cycle management procedures in place. According to reports, the market for revenue cycle management is anticipated to reach $1.209 trillion by 2030.

Furthermore, according to statistics, the global big data industry is anticipated to grow to $103 billion by 2027 and $90 billion by 2025. To get real-time insights and streamline operations, nearly every industry is investing in big data analytics and business intelligence solutions.

What is a revenue cycle, though? What function does an organization’s revenue cycle analytics serve? How can a company use big data and business analytics to extract sophisticated analytical insights from revenue cycles?

What is the Revenue Cycle Process?

A revenue cycle consists of several repeating processes required to finish an accounting procedure and document the money made by the company. This entails keeping track of sales, returns, claims, offers, and other transactions. Revenue cycle analysis aids in establishing your company’s financial health and identifying additional growth opportunities. By analysing different company processes and providing insights on how to improve overall efficiency, it can raise your sales and profitability. It also contributes to raising client satisfaction levels with your company. When a customer places an order, the revenue cycle process begins, and it concludes when payment is received. Every time a consumer places an order, it repeats. The components of the revenue cycle process are as follows:

• Receive orders from clients
• Complete the order.
• Create invoices and bills.
• Deliver the products or services.
• Keep a record of the transaction.
• Receive the money.
• Do this for each order.

The Importance of Revenue Cycle Management in Medical Billing

The basis of the revenue cycle is medical billing. Billing errors may result in denied claims, postponed payments, and lost income. In medical billing, revenue cycle management entails precise coding, timely claim filing, and careful follow-up on delinquent payments. Take into account the following elements of your medical billing procedure while assessing your revenue cycle:

1. Accuracy in Documentation and Coding: Are your medical coders trained to follow the latest coding standards like ICD-10 and CPT? Errors in coding can lead to rejected claims.
2. Timeliness of Claims Submission: Delayed submissions can result in denied claims due to missed deadlines. Regularly track the time it takes from patient visit to claim submission.
3. Denial Management: How often are your claims denied? Are there patterns or recurring issues causing these denials? Effective RCM includes identifying and correcting these issues quickly.
4. Patient Billing Transparency: Ensure that patients understand their financial responsibilities upfront. Transparent billing leads to fewer disputes and quicker payments.

Leveraging Revenue Cycle Management Technology

The way healthcare providers manage billing and collections has changed as a result of the incorporation of technology into revenue cycle management. RCM technology improves efficiency, lowers errors, and streamlines the process.

• Automated billing systems: By minimising human error in billing and coding, these systems guarantee that claims are filed on time and correctly.
• Integration of Electronic Health Records (EHR): Accurate documentation and quicker claim submissions are made possible by the seamless integration of billing data with patient records.
• Denial Management Tools: By using sophisticated tools to spot trends in claim denials, practices can take proactive measures to resolve problems.
• Patient portals: By offering insurance information, payment alternatives, and clear billing statements, these portals increase patient engagement while cutting down on the time and effort required to collect payments.
• Data Analytics: To learn more about the performance of your revenue cycle, use data analytics tools. 

How to Evaluate Your Revenue Cycle Process Effectively?

A comprehensive revenue cycle analysis will help your practice prevent claim denials and guarantee that you get paid on a regular basis for the services you provide. Increased profitability is one of the biggest benefits of fewer denials for your company. The following elements should be examined in your revenue cycle analysis.

1. Key Performance Indicators

You need to be familiar with the key performance indicators for your practice in order to understand your revenue cycle. After identifying these, compare performance metrics to industry best practices, taking into account net recycling rate, days in account receivable, and other factors. This kind of research will assist your strategy in identifying potential development areas.

2. Current Processes for the Revenue Cycle

The process itself should be the main focus of your billing process analysis. Your revenue cycle, which starts with registration and ends with insurance follow-up, is intricate. By examining the process from start to finish, you can find areas for improvement by analysing how long it takes to complete each phase.

3. Utilised Revenue Cycle Assets

There is no doubt that the revenue cycle of your profession includes the use of specific technology. You should take the time to determine which resources and supplies are utilised for each task along the way. Please talk about the resources that your team finds most helpful and how they view the process being handled.

4. Plans for Staffing

Your strategies should also evaluate the number of employees in your company. Work with your team to review procedures, determine who is needed at each step, and determine how much time is spent on each step based on factors including patient information, speciality, and required technology. You can also take advantage of this chance to manage any future staffing needs brought on by your new objectives.

Wrapping Up

Revenue cycle management facilitates data-driven decision-making for enterprises. This information, which is gathered from several sources, provides a more comprehensive view of the business’s financial status.

Enhancing business efficiency, cutting unnecessary expenses, optimising resources, raising employee and customer happiness, and increasing revenue are further objectives of revenue cycle analytics. For customised revenue cycle analytics solutions, be sure to collaborate with a reputable managed data analytics firm. By understanding the basic components of RCM,If you’d like to learn more about how CureCloudMD enhances your organization’s bottom line, we’d be pleased to get on a brief call to discuss your needs and goals.