Electronic RCM: The how, why and wow!

A common challenge faced by healthcare providers is capturing data from the Explanation of Benefits (EOBs), extracting this information and sending it across to other departments such as core accounting and other management systems. While this sounds easy, most service providers process 5000 or more EOBs every day, manually!

It’s time to step up!

In the current market, with increasing competition, it is imperative to stay on top of your game by maintaining customer loyalty. Switching to an electronic Revenue Cycle Management (RCM) system ensures streamlined information processing, rapid turn-around, and competitive pricing. Intelligent technology reduces manual effort allowing the service providers and customers to tackle other challenges.

How does it work?

RCM simply brings together the data from the healthcare provider with that of the insurance provider in a single platform. While it is a complex process, automating certain stages of the cycle can offer significant benefits. These include:

  • Improved efficiency

    If you are going to manually enter data, you run a high risk of error. An intelligent workflow introduces higher levels of accuracy & speed, while processing multiple claims!

  • Identify and resolve discrepancies

    If insurance providers were given an insight each time a claim was denied, how much of a difference do you think it would make? RCM offers you a chance to understand how the system works on an intuitive level, and gives you an opportunity to fix the issue. Specifically, an electronic RCM system reduces denied claims by prompting healthcare employees to enter all the information required for claims processing, further ensuring service providers are reimbursed for taking care of Medicare patients. This saves them time, effort, and by extension, money from having to revise/resubmit the claim.

  • Maintain accurate customer records

    An RCM works effortlessly without inconsistencies such as duplicate data entries, incomplete reports, incorrect entries by centralizing the entire system. This allows for a particular patient’s data to be accessed by other providers in a approval-based manner.

  • Assisting with HIPAA compliance

    A programmed system ensures that your client’s data stays private and protected [emails, documents, and scans] while allowing healthcare providers to share data securely to ensure the best possible patient care.

Apart from the above, an electronic RCM system saves time and money. Tasks previously handled by employees such as administrative duties are now automated, viz., informing patients of upcoming appointments, reminding patients of an existing balance and getting more information from patients when a particular claim is denied.

How to choose?

The most important criteria in choosing an electronic RCM that works for you is seamless integration with your existing accounting and management systems. Secondly, the technology used should be intuitive, providing analytics for better patient insights, with intelligent data mining. Thirdly, automatic capture of data and validation to improve HIPAA compliance goes a long way in ensuring customer satisfaction and loyalty.

The final word

In short, an electronic RCM system ensures that you can track patient care from the first form to scheduling, as well as periodically reminding them about appointments, and the final payment, sans the manual labour.

Insights gained through RCM will allow healthcare providers and insurance companies to figure out what percentage of their patient population suffers from which chronic disorder and analyze their data. This will assist in eventually moving from a fee-for-service industry to value-based reimbursement sector.

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