In the healthcare industry, revenue cycle management (RCM) is the foundation of financial health. Revenue cycle management can spell the difference between struggling to survive and flourishing financial success.

From small practices to large health systems, every healthcare organization needs to develop systems and processes in order to stay financially healthy—and that’s where revenue cycle management comes in.

As healthcare regulations, patient trends, and technology are changing at an increasingly rapid pace, it is more crucial than ever for providers to evaluate their need for more reliable and better revenue cycle management solutions.

Due to COVID-19, 75 percent of hospitals and health systems across the United States will permanently change revenue cycle management, according to a 2020 HFMA Pulse Survey.

The move toward value-based reimbursement, patient consumerism, and the pandemic aftermath has pushed providers to take a closer look at the way they approach revenue cycle management.

What is revenue cycle management (RCM)?

RCM
RCM

Revenue cycle management (RCM) is the financial process of handling billing, payment processing, and revenue collection within a corporation.

RCM involves managing, collecting, and optimizing the revenue generated by medical services provided to patients.

It also covers a wide aspect of a healthcare organization’s operations—from financial strategy and policies to appointment scheduling, eligibility verification, coding, billing, claim submission, denial management, etc.

In healthcare, an end-to-end revenue cycle management process cycle begins when the patient makes the appointment and ends with successful payment collection or the write-off the bill.

For other industries, such as retail, this process can be completed almost instantaneously. However, in healthcare, it is a much more complex process.

The Healthcare Financial Management Association (HFMA) defines the healthcare revenue cycle as “all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue.” The revenue cycle process encompasses the entire life of a patient account.

Here are the major steps involved in revenue cycle management:

  • Pre-registration and Pre-authorization: Before a patient arrives for inpatient or outpatient procedures, providers obtain pre-registration information such as insurance coverage, financial and demographic information, and eligibility.
  • Registration: This step involves collecting subsequent patient information during registration and ensuring that patient information is 100% accurate. Providers also collect and ensure a referral or authorization is in place to treat the patient.
  • Charge Capture and Coding: This stage involves rendering medical services into billable charges and properly coding diagnoses and procedures which in turn determine reimbursement amounts.
  • Claim Submission: This step involves submitting claims of billable fees to insurance companies as well as verifying that claims are clean and going in the door correctly (claim scrubbing).
  • Remittance Processing and Denials Management: Once claims have gone out, providers will get remittances back. This step involves applying or rejecting payments through remittance processing. If this process and the reports are not being reviewed, providers could miss the chance for an appeal and the opportunity of correcting a mistake.
  • Third-party / Insurance Follow Up: In this stage, providers look at what has been paid and what has not been paid and then communicate with insurers regularly to collect reimbursements without errors or denials.
  • Patient collections: Once payer reimbursement is on its way, out-of-pocket cost is then posted for the patient to pay. This step should also include quality patient collections services from RCM service vendors.

Why is having a robust revenue cycle management (RCM) process important in healthcare?

Revenue Cycle Inefficiencies
Revenue Cycle Inefficiencies

Effectively managing revenue is essential for any kind of business to ensure that incoming cash is sufficient to pay for expenses.

Due to the complexities of billing and revenue collection in healthcare, revenue cycle management plays a critical role in ensuring a healthy bottom line.

In the United States, 15% of every healthcare dollar spent goes toward revenue cycle inefficiencies, according to a McKinsey research.

Inefficient processes across the revenue cycle can cost healthcare providers billions of dollars each year.

When revenue cycle performance lags across key areas, the average 350-bed hospital misses roughly $22 million in revenue capture opportunities, according to the Advisory Board.

Partnering With Mnet Health: The Premier RCM Company

Providers look to Mnet as their trusted RCM partner to transform their revenue cycle and provide the ultimate financial experience to their patients.

Working with over 900 surgical hospitals and ambulatory surgery centers across the US, Mnet Health is the premier Revenue Cycle Management (RCM) and technology company providing customized patient-pay solutions.

By working with Mnet, one surgical hospital increased their cash flow by $1.8 million and reduced their bad debt by $1.1 million in the first year alone with its First Party Billing Solutions.

Mnet helps providers tap into the consumer-driven mindset of today’s patients, empowering them to take charge of their financial situation using integrated payment technologies like PaySuite and Text-to-Pay.

Key to Mnet’s success with its clients are its Patient Financial Advocates who can communicate in over 200 languages—whether patients want to make a payment, set up a payment plan, or need help understanding their bill.

Mnet operates seamlessly with your facility to bring end-to-end revenue cycle management and help your facility earn millions by improving your revenue cycle and transforming the patient financial experience.

The value that the right RCM partner can bring to the table is immense.

Choosing the right partner for revenue cycle management can help your facility increase cash flow, maximize revenue, reduce expenses, and improve patient satisfaction.



About Mnet

We believe every patient deserves a helpful, transparent, easy-to-navigate financial experience in healthcare.

Mnet is the premier revenue cycle management & technology provider to the surgical industry. Mnet provides customized patient-pay solutions to surgical hospitals and ambulatory surgery centers. Mnet Health partners with over 900 surgical facilities nationwide and is the preferred vendor to the leading ASC management companies in the US both directly with and in support of centralized billing offices.

Mnet’s tailor-made brand, PaySUITE, is a white-labeled payment technology platform that helps surgical facilities, and their providers grow their business by helping patients pay. Mnet’s patient-pay solutions significantly increase self-pay collections while creating a better financial experience for patients. For more information, visit mnethealth.com.