Revenue Cycle Management (RCM) is the process by which healthcare organizations manage the financial aspects of patient care, from the initial appointment to the final payment. Effective RCM is crucial in healthcare as it ensures that providers receive timely and accurate payments, which helps maintain the financial health of the organization. We’ll discuss the financial benefits of implementing an effective RCM system, highlighting how it can lead to increased revenue, reduced costs, and improved cash flow.
Efficient healthcare claims management systems lead to increased revenue by ensuring faster and more accurate claim submissions. By setting up test mode for the claims submission process, providers can validate a claim and catch errors in the billing and coding procedures before submitting to payers. For example, Oystehr’s healthcare RCM software streamlines the validation and submission of claims to payers, resulting in fewer errors and significant savings in time and money.
In addition to increasing revenue, effective healthcare RCM reduces costs by minimizing administrative overhead and claim denials. Automated processes, such as real-time insurance eligibility checks and claim validation, reduce the need for manual interventions and reworks, lowering administrative expenses. Oystehr’s RCM solutions streamline these processes, making the entire revenue cycle more efficient.
Improved cash flow is another significant benefit of efficient healthcare revenue cycle management. Timely payments from both health insurance companies and patients ensure that healthcare providers have a steady cash flow, reducing the days in accounts receivable. Oystehr’s RCM module helps enhance financial and operational performance by ensuring that payments are processed promptly, improving cash flow management and working capital.
If you look at the traditional process of insurance validation and claims submission today, it can involve labor-intensive tasks with reliance on outdated information, requesting information from insurance companies, and claims preparation, which are prone to errors and delays. Finding an interoperable EHR that can automate these processes will resolve many of these issues.
Technology plays a vital role in achieving financial efficiency in RCM. Oystehr’s solutions automate and streamline various stages of the revenue cycle, from patient registration to insurance validation and claims submission. This automation reduces human errors and administrative burdens, leading to a more efficient revenue cycle process.
Key features of Oystehr’s RCM module include real-time insurance eligibility verification, automated claim validation, and seamless integration with FHIR (Fast Healthcare Interoperability Resources). Since Oystehr integrates directly with insurance databases, this removes the friction of manually requesting insurance eligibility and the need to integrate with multiple insurance companies. When an eligibility check is submitted, Oystehr automatically generates FHIR resources that capture payer and patient data. These resources are securely stored in the project's FHIR store, enabling access to the patient record and facilitating further processing.
When you’re ready for billing, our Zambda functions allow you to automate data configuration to any biller, such as CMS 1500 forms, removing manual steps in your billing process.
Integrating your claims system with your patient data ensures a seamless transition of data between clinical and administrative functions, reducing the burden on healthcare professionals and improving the overall patient experience.
A notable example of the financial benefits of effective revenue cycle management (RCM) is the case of FlexTogether, a virtual pulmonary rehabilitation clinic. Before integrating Oystehr into their operations, FlexTogether struggled with a time-consuming billing process that required significant human resources. Claims often experienced delays of weeks before submission, with the added burden of manual data entry. These inefficiencies hindered the clinic's overall effectiveness and operational efficiency.
After adopting Oystehr's solutions, FlexTogether saw a dramatic improvement in their RCM process. They saw an 80% time reduction in handling claims, submitting within minutes rather than days, and the improved Days Sales Outstanding (DSO) metrics have significantly increased the clinic's working capital. The automation provided by Oystehr allowed FlexTogether to redirect resources from manual claims processing to acquiring more patients and enhancing the quality of care provided. This operational efficiency has not only improved financial outcomes but also positioned FlexTogether to expand its reach and impact within the virtual pulmonary rehabilitation landscape.
By leveraging Oystehr's FHIR datastore and APIs, FlexTogether streamlined the transmission of claims data, facilitated real-time management of payments and denials, and ensured seamless integration with CMS 1500 billing forms. This goes to show how effective RCM can lead to substantial financial improvements, reduced administrative costs, and better patient care, making a compelling case for the adoption of advanced RCM technologies in the healthcare industry.
In conclusion, an efficient RCM system offers numerous financial benefits, including increased revenue, reduced costs, and improved cash flow. By automating data flow, insurance validation, and claims submission process, healthcare organizations can achieve greater financial stability and operational efficiency. Healthcare leaders and professionals are encouraged to consider Oystehr’s RCM solutions for optimizing their revenue cycle and enhancing their financial performance.
To learn more about how Oystehr’s RCM module can help your healthcare organization streamline its revenue cycle process and achieve financial success, schedule a demo today. Oystehr’s RCM solutions provide the tools and technology needed to transform your revenue cycle management and improve your financial outcomes.
Effective Revenue Cycle Management (RCM) enhances patient satisfaction by ensuring clear and accurate billing, reducing billing errors, and minimizing unexpected charges. Streamlined RCM processes lead to quicker claim processing and fewer billing disputes, resulting in a more positive financial experience for patients and allowing healthcare providers to focus more on patient care.
Small healthcare practices often manage RCM with fewer resources and staff compared to larger hospitals, relying more on outsourced services or simpler RCM software solutions tailored to their scale. They may also face greater challenges in maintaining comprehensive in-house expertise for managing the complexities of insurance verification, coding, and compliance, which larger hospitals can handle more robustly with dedicated RCM departments.
To reduce claim denials, healthcare providers can implement thorough insurance verification processes, ensure accurate and detailed clinical documentation, and provide ongoing training for medical coders on current coding standards. Additionally, using advanced RCM software for real-time error checking and establishing a robust denial management system to promptly address and correct denials can significantly decrease the rate of claim rejections.
Looking to build your own revenue cycle management module for your organization?
Request Free Access today to try out Oystehr.
.webp)
Our new behavioral health intake application, built on Oystehr, allowed us to build a solution that is customized for our use including scheduling, insurance validation, and direct integration with our eClinicalWorks EHR.
.webp)
Chief Medical Information Officer at PM Pediatric Care
.png)
%201.svg){kind=small}