Revenue cycle management (RCM) isn’t a singular event. It involves the relationship between the patients, providers, employees, payers and an overall understanding of the business process. Identifying areas for improvement in this cycle develops a better relationship between all of these individuals. A more harmonious work environment will also be created when operational efficiencies are developed.

RCM is a fairly new term in health care; it’s similar to what was previously known as a medical practice assessments. There are at least a dozen areas that can be isolated in this cycle. Segregating them for evaluation purposes is a recommended step to improving the overall operations.  So, what should you know about a RCM analysis?

 

RCM breaks the revenue cycle into three areas:


The Front End
Includes pre-visit and visit activities such as patient scheduling/registration and co-pay/deductible collections.
Transaction Processing
Includes claims submissions, collection processing activities and the posting function.
The Back End
Includes all accounts receivable tasks involving both the patient and the payer.

Each component of RCM plays a distinct, yet integrated, part of the process. The better these relationships are understood, the better the overall outcomes will be when changes are implemented.  

 

Associated signs and symptoms are critical to a RCM analysis.

The RCM analysis gives you a way to holistically address issues within your revenue cycle. For example, if your practice is experiencing a problem with its accounts receivable and collections, it could actually stem from a completely different area of the revenue cycle. By looking at all areas of the revenue cycle, RCM allows you to see the connection and resolve the real source of the issue.

An analysis also lets you see how a change—such as when a payer renegotiates a contract—will truly affect your practice. Let’s say a payer allows your practice to increase prices by three percent, in the aggregate. What does this increase really mean? How will this impact your pricing and revenues? A RCM analysis will help you know what to expect.

 

The more you know about RCM, the better.

The first step to thrive (not just survive) the changes taking place in health care is to understand your revenue cycle. The more you know about the entire patient experience and how to account and track for those activities, the better you’ll be able to maintain the health of your practice.

How does DS+B implement a RCM analysis? We take a systematic approach, similar to a patient encounter. We start by discussing the operations with management. Next we identify areas of concern.  Last we evaluate the specific systems, draw conclusions and make recommendations that you can actually implement.