RCM Challenges Faced By Hospitals

Hospital Revenue Cycle Management is a financial process in the health care services that utilizes medical billing system to track patient care - from registration to appointment scheduling and the final payment of a balance. It unifies the clinical and business sides of healthcare by coupling administrative data, such as the patient’s name and other personal information with the treatment he or she receives and their healthcare data. Here are a few things involved in revenue cycle management: 

1. Preregistration: This involves the collection of information about the patient such as the insurance coverage before a patient goes into inpatient or outpatient procedures. 

2. Registration: Collecting subsequent information about the patient during the process to establish a medical record number and meet various regulatory, clinical and financial requirements. 

3. Charge capture: This process involves rendering medical services into billing charges. 

4. Coding: This step includes coding proper diagnoses and procedures 

5. Remittance processing: Applying or rejecting payments through the process of remittance. 

Other than these, it also includes a third-party follow-up, claim submissions and a utilization review. While RCM plays a vital role in health care organizations as it helps manage bulk tasks with ease. But in some situations and circumstances, this can get slightly tricky as well. 

1. Lack of Trained Professionals: It is extremely important to collect accurate and precise the patient’s information. When the staff is not provided with the necessary training required to carry this process out, it can get difficult. The organization may have to pay huge penalties. Hence, RCM requires well-trained and professionals who are technically sound to carry out the task with ease. 

2. Error while preparing and collecting a bill: A wrong bill or other forceful methods adapted to collect revenue can affect the entire RCM system. The staff should take extreme care while carrying out the billing process. 

3. Lack of systematic financial policy: Financial policies are essential in an RCM system and hence should be documented and evaluated properly. An effective financial policy can help health professionals understand the financial status of their patients and also depict if there are any unclaimed amounts on the procedures. Therefore, maintaining an orderly financial policy can avoid any kind of loss. 

Many hospitals are turning towards outsourcing healthcare account receivable management systems to fill up the gap and reduce the write-offs and to give their business a financial boost. 3 Gen Consulting provides the most sustainable and comprehensive RCM systems throughout the globe. Contact us to know more.