Revenue Cycle Management (RCM) is the process of optimizing a healthcare organization's financial performance by efficiently managing patient billing, claims processing, and payment collection. While IT systems can improve efficiency, the inherent complexity of healthcare operations often necessitates human intervention. Billers and AR specialists must ensure that claims are accurate, get paid promptly, and are reconciled within billing systems. Frequent follow-ups with payers and timely payment posting are essential to keep ledgers balanced. With the shifting regulatory guidelines and varying payer requirements, these tasks become increasingly challenging, leading to denials, delayed payments, and financial losses. At Nalashaa Healthcare Solutions, we specialize in providing healthcare revenue cycle management services and solutions that blend technology with deep industry expertise. Our experienced team ensures accurate claims submissions, swift payment postings, and effective AR management, helping healthcare providers maintain financial stability and optimize cash flow in an ever-evolving industry.
Challenges in Healthcare Revenue Cycle Management
Medical revenue cycle management comes with challenges that can disrupt cash flow and operational efficiency.
Claims Accuracy
Ensuring claims are accurate is challenging due to varying payer requirements. Mistakes can lead to rejected claims, delay payments, and cause extra work for billing teams.
Denial Management
Frequent changes in payer codes, especially during transitions like MCO updates, often result in claim denials. Billers must spend time addressing these denials manually, which can slow down cash flow and create lost revenue opportunities.
Eligibility & Pre-Authorization
When eligibility checks or pre-authorization are missed early on, billers have to chase down payers later, leading to extra manual work. Automating these tasks could significantly reduce the workload for billing departments.
Coordination of Benefits (COBs)
Many billing systems still require manual handling of COBs, increasing the workload for billers. Advanced systems can automate this process, but many providers are still struggling with inefficient systems.
Payment Posting
Even after payments are received, recording them accurately in billing systems can be time-consuming and prone to errors. Mistakes here can lead to reconciliation issues and slow down revenue recognition.
Aging Accounts Receivable (AR)
Tracking overdue payments requires constant follow-ups, overwhelming billing teams. When AR isn’t managed efficiently, it leads to missed payments and disrupts cash flow.
B2C Collections
With more patients bearing financial responsibility, collecting payments from them is becoming harder. Most billing systems aren’t well-equipped to handle patient collections efficiently, increasing the cost and time involved in recovering payments.
Custom Reports
Billing teams often need to create custom reports for providers, which requires significant time and effort. Modern tools could help providers quickly interpret this data and make decisions faster.
Manual Tasks
Billers spend a lot of time on repetitive tasks like data entry and clicking through systems. Automating these processes would save time and allow billers to focus on more valuable work.
Human Oversight
Despite automation, tasks like payer communication and reconciliation still require human intervention, which increases the risk of delays and mistakes.
Things we can do for you
The biggest concern providers and billing organizations have today is to get the right money in at the right time. With experience, billing departments acquire the knowhow of how to bill in order to get the maximum reimbursements without risking penalties. As the number of qualified billers dips in the US, its cumbersome to train the new staff on this to minimize revenue loss. With experienced people who have had exposure to various care settings, we can help you get your money in within the specific window of time. If your RCM cycle is broken, we can help you fix it by
With MCO transition, shift from FFS to VBC, Chronic care management and many other contextual changes, getting the right reimbursements quickly has become trickier. While the claim process is mostly electronic (barring a few exceptions), what goes into the claims is paramount. We shorten your revenue cycle and improve your cash flow by
- Creating and sending electronic claims to Medicare, Medicaid and private payers
- Ensuring the eligibilities before the claims go out, to minimize the rejections
- Handling the COBs with secondary and tertiary payers
- Ensuring enrolments (which are vital at the time of MCO transition) to ensure payments
While getting the payments in time is vital, its equally important to balance the books. We automate the posting processes to minimize the time and effort spent in tallying charges and payments. The intent is to give all the stakeholders as current a picture as possible by
- Posting payments into your billing system
- Handling adjustments, write-offs, overpayments etc.
- Managing the outstanding claim queue
Given the complexity of healthcare settings’ context of operation, variety of plans, changing regulations among many other things, rejections and denials aren’t a surprise to anyone working in the billing department on the providers end. Though it’s a reality, one needs to make sure that the money that the providers are entitled to, reaches them. We make that possible through people who know their ways to accelerate settlements by
- Tracking, Reporting and following-up on aging claims
- Calling up the payers to seek detailed reasons for rejections/denials
- Building a case for the providers to get paid for the right amount
- Giving you a clear picture of your money by leveraging self-service reports
Benefits of Healthcare Revenue Cycle Management Solutions
Effective medical RCM services deliver benefits that can improve operational efficiency and financial outcomes for healthcare providers
Faster Payments
Better claims submission and follow-up processes result in quicker payment cycles that reduces delays and improve overall cash flow.
Fewer Denials
Thorough eligibility checks and accurate claim submissions help reduce denials, minimizing the need for resubmissions and the associated delays.
Accurate Payment Posting
Automation ensures precise payment posting, including managing adjustments, write-offs, and overpayments, keeping financial records balanced and up-to-date.
Improved Accounts Receivable
Proactive tracking and follow-up of aging claims help keep accounts receivable in check, maximizing revenue collection and minimizing outstanding balances.
Reduced Administrative Workload
Proactive tracking and follow-up of aging claims help keep accounts receivable in check, maximizing revenue collection and minimizing outstanding balances.
Customizable Solutions
Hospital RCM services can be tailored to the specific needs of healthcare providers such that both large hospitals and smaller practices can optimize their revenue cycle.
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A glimpse of our industry expertise
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