What is Next Generation Revenue Cycle Management?

Revenue Cycle Management

In the business of healthcare, revenue cycle management covers all of the processes that encompass with collection and measurement of revenue to you and your practice. This should include registration, eligibility verification, coding and claim preparation, claims submission and processing, insurance collections, rejections, denailas, appeals, patient responibility collections,payments posting, financial analysis and reporting, financial projections, and all other relevant tasks for revenue generation and colleciton. In other words, it should help you monitor your claims and payments throughout the life cycle of your practice. The revenue cycle begins when a patient first schedules an appointment and ends well beyond the collection and posting for all payments for that encounter.

The Ins and Outs of Next Generation Revenue Cycle Management

next_generation_revenue_cycle_mangement Next generation revenue cycle management aims to improve service to patients and reform healthcare payment and delivery systems by taking advantage of the new regulations driven by the PPACA. Shifting the focus from the current fee-for-service system to a value-based system can enable incentives for both preventive care and extended treatment plans for chronic care.

With the legacy fee-for-service structure, revenue is primarily driven by volume. Patients are billed per visit, per item, or per service which may end up looking like shopping list healthcare. The next generation revenue cycle approach is a way of addressing value-based care which actually structures health treatment programs for your patients. For example, you can take advantage of bundled payments, where you receive a fixed amount for a bundle of services or an overall care program that the patient is expected to need during a defined time period for the entire episode of care. This creates an incentive to provide better overall care coordination and cost containment.

Implementing Next Generation RCM – Why & How

As you look to implement next generation RCM methods, you should assess what your practice needs as a whole. Evaluate your current revenue cycle processes to determine if they are thorough enough to take on the new requirements as is, or whether you need to look for help in implementing better processes. During this time, be open to service providers who can take you to a new level of revenue cycle management and establish a clear vision on how new processes can best serve your patients and you practice. While many new technology solutions are appearing to fill the need in this space, consider your options carefully and don’t make hasty decisions until you fully understand what you need and what solutions are available. It is unlikely that simply implementing a new technology will meet all your needs.

When you begin to assess how to implement a value-based revenue system and are looking for service providers to get you there, keep the following basics on your list of needs:

  • Help on improving overall monthly cash flow by addressing the delays caused by manageing regections, insurance denials and appeals, and collection activities
  • Maximize reimbursements by documetning to the highest specificity allowing for the correct application of higher reimburing codes
  • Compliance expertise for both old and new regulations that can have negative or possitive affects (penality or incentive) on your reimbursement levels
  • Experience and expertise around revenue cycle management to enhance overall efficiency
  • Knowledge and experience with the new payment paradigms available in the marketplace today

Leave it to the Experts

HIS specializes in helping define your needs around your revenue cycle management and in providing both consulting and outsourced support service to implement, manage, and perform new processes. Our partnership-based services and solutions can help take away the stress of dealing with financial aspects and let you focus on your practice and your patients. With next generation revenue cycle management and a full-suite of other services, our goal is to help practices be successful, both financially and in their patient satisfaction.