How modern technology in healthcare has been essential to the growth of the healthcare sector over the decades. In the past, diagnosing and treating patients required a lot of work and resources due to their complexity. That said, rapid technological development has facilitated the creation of cutting-edge medical tools, affordable medications, and ground-breaking techniques that have streamlined every aspect of medicine and raised the standard of healthcare.

Modern technology in healthcare sector:

On the other side, to effectively meet patients’ needs and maintain its position in the market, the healthcare system must constantly change and advance at the same rate as technology. Besides, the healthcare system has faced numerous issues recently, including

• Rising medical costs
• Inadequate patient-specific care
• Ineffective procedures
• Growing number of patients with both acute and chronic illnesses

With the Corona virus pandemic, the healthcare systems’ capacity and capability are being put to the test, and many health centers are overworked and understaffed in order to handle the escalating patient load. Moreover, both patients and healthcare professionals are directly impacted by the evolving trends in the medical field. From the perspective of the patient, healthcare centers mostly circle around the:

• Insurance coverage which indicates whether the patient can afford the costs of either chronic or acute illness treatment
• A close-by supply of medical facilities and services
• early disease detection, treatment, and prevention

The adoption and implementation of technological solutions, such as cutting-edge machinery and digital transformation with cutting-edge software and systems, is the answer to almost all of the problems facing the healthcare sector.

How digital technology is changing the face of the medical field?

Wide-ranging healthcare tasks like data collection, research, medical billing and coding, remote monitoring, adherence to health regulations, and timely diagnosis and treatment have all benefited greatly from digital technology. The biggest benefit of technology is that it streamlines every task, saves time, lessens mechanical paperwork, and eliminates any errors that might have an impact on the entire medical procedure.

A medical facility, such as a hospital or doctor’s office, is in charge of providing patients with the proper healthcare services and managing their finances to pay the healthcare providers’ salaries and keep the cost of treatment under control. This includes paying for procedural treatment, supplies, and overhead.

Every medical practice relies on the revenue cycle management (RCM) process to make sure that patients are charged fairly and, more importantly, that healthcare professionals like doctors, nurses, therapists, lab technicians, and social workers are properly compensated for their specialized services.

The patient registration phase of the revenue cycle is followed by the healthcare provider receiving full payment for the medical services rendered. Medical coding and billing are two distinct but related processes that are essential for a successful medical revenue cycle management company.

Medical Coding

Medical coding is the process of taking a patient’s diagnosis and treatment notes and turning them into the appropriate alphanumeric codes for accurate billing and record-keeping. Current Procedural Codes (CPT) codes, International Classification of Disease (ICD) codes, and Healthcare Common Procedure Coding System (HCPCS) codes are a few examples of the various types of codes.

Medical Billing

Medical billing refers to the process of creating accurate patient claims or invoices based on coding and sending them to insurance companies for payments. Based on codes, insurance companies will approve or deny payments. The patient will receive any payments for medical services that are not covered by their insurance plan. As soon as a patient schedules an appointment with a medical office, the billing procedure gets started.

Medical Billing and Coding Software Has the Following Goals:

The majority of medical coding and billing up until the 2000s was done manually, which required a significant amount of paperwork both before coding and after billing the claim. If the insurance provider refused to pay because of a coding or billing error, the paperwork grew.

In times of global pandemic, it can be challenging for medical practices to train and recruit personnel who can handle both the coding and billing tasks effectively. Claims that are incorrectly processed can have a direct impact on the revenue cycle. Medical billing, on the other side, is a meticulous task that requires valuable time.

Moreover, the process of processing claims and collecting payments is being completely redefined by hospital billing software solutions. Besides, the ability for the medical staff to concentrate on managing better patient care is the biggest benefit, along with process simplification and error reduction.

Electronic Health Records (EHR) have proven to be very useful in the healthcare sector, particularly for doctors. Compared to paperwork, EHR makes it easier to maintain an accurate and comprehensive patient record.

Traditionally, to create a patient’s medical record into the database, medical professionals had to manually enter codes into the specialized computerized systems. Moreover, medical codes depend on the diagnosis and treatment for a particular patient and are complicated because there are so many different kinds of acute and chronic illnesses.

On the other side, Medical practices are required to update the changes in codes as a result of the ongoing changes in the healthcare industry. That said, medical billing and coding specialists may find it difficult to keep up with all the changes, but the right software can update the codes accurately and efficiently. Besides, the patient’s medical records can also be easily updated using the software solutions in accordance with newer medical codes.

On the other hand, the speed of medical billing and coding has significantly increased thanks to the development of artificial intelligence and automation. In these Covid-19 times, coders can easily work remotely and from their homes rather than being on-site due to lockdown and social isolation. The sophisticated applications on modern computers and even smartphones are primarily made to assist with medical coding.

The benefits of software solutions for Medical billing and coding:

Nearly 30 years ago, the only source of healthcare information was paperwork, which was a laborious and time-consuming task. The use of medical billing and coding software, however, is restructuring and enhancing health information management. Moreover, the need for specific healthcare services and medical professionals is anticipated to rise as the baby boomer generation ages.

The information of a patient, including symptoms, diagnoses, and treatments, is converted into an electronic code by modern medical coders using software. This electronic code is then easily stored in the patient’s database, which is then managed by the medical practice. In order to get payment from insurance companies, the code or information is used to create a medical bill.

With just a few clicks, today’s medical coding software, known as a “encoder,” makes the entire coding process quick and easy. Moreover, the software makes it simple to choose from among the hundreds of different codes, all of which can be challenging for a professional to memorize. The codes are also continuously updated.

On the other hand, professional coders are also required to use their knowledge and skill to ensure that the correct medical claim is processed. Besides, encoders assist in identifying and choosing the appropriate code for a specific diagnosis or procedure. Moreover, the benefits of utilizing complex coding and billing solutions include

• giving medical practices a suitable platform to keep track of patients’ medical histories, diagnoses, and treatments
• quickly determining the insurance status and eligibility
• enhancing the billing and coding procedures significantly and removing any errors
• Making sure that insurance companies receive accurate claims without the possibility of a rejection
• facilitating prompt payment of medical bills to the provider of care
• Tools for analytics to facilitate quick reporting and scheduling

Final words

Once the benchmark of collections has been reached, medical claims are processed more quickly and staff can focus on treating patients rather than filling out endless paperwork. So, we can say that the role of digital technology in the healthcare sector currently is more crucial than ever.

Revenue Cycle Management – Why Every Healthcare provider is taking it more seriously than ever?

What’s the first thing that strikes your mind once you hear the term ‘Revenue Cycle management’? While it may sound like a typical business management function, it covers a myriad of domains and industries.

In a layman’s language, we can define revenue cycle management as a strategy that healthcare providers can employ to manage the administrative and clinical aspects of their revenue cycle. The moment a patient contacts the healthcare provider to make an appointment, the revenue cycle starts. Moreover, once all payments have been received for the consultation and therapy, the cycle can be termed as ‘over’.

On the other side, the purpose of revenue cycle management is to locate and address any points of friction in the provider’s revenue cycle. Doing that, healthcare providers can maximize their claim reimbursements and raise their revenue in the long run.

Functioning of Healthcare Revenue Cycle Management

Revenue cycle isn’t just a single function and it brings over several entities to play at the same time. Besides, there are numerous steps in the revenue cycle for healthcare. Well, this indicates that there are numerous opportunities for mistakes to happen and any errors in the revenue cycle have the potential to stall or delay the provider’s ability to get paid by patients and insurers.

That said; let’s look at the steps in the healthcare revenue cycle to get a better idea of where errors can happen and how RCM can prevent them:

Pre-authorization and eligibility verification – The healthcare provider gathers data to create a patient account when a patient schedules an appointment. This involves gathering the patient’s insurance details and confirming their eligibility for coverage.

Even if a patient already has an account with the provider, revenue cycle management company places a strong emphasis on accurately completing this step. A claim denial later in the revenue cycle will only be the result of inaccurate information or ineligible insurance. This indicates a delay in the reimbursement payment to the provider. Additionally, it adds to the provider’s workload because they must go over the patient’s records again to fix the mistakes.

Charge capturing and coding: Using generally recognized medical codes, charge capturing converts patient services into billable charges. That said, insurance companies use these codes to calculate reimbursement amounts.

The insurance provider might reject the patient’s claim if the medical records are not properly coded. As a result, provider reimbursement is delayed. Additionally, it costs the provider time and money because appeals and investigations are required for denied claims. Coding accuracy is ensured by effective revenue cycle management company in texas, allowing denials to be completely avoided.

Submission of claims – Following accurate coding of a patient’s treatment, a claim is submitted to the insurance provider for approval. RCM manages and tracks the claim from the outset of the process to ensure that it is submitted as soon as possible.

Payment collection – After the insurance company has granted the patient’s claim, the provider is paid according to the patient’s eligibility. The provider must contact the patient to obtain any unpaid balance if there is any after the insurance company has paid its share.

So, technically, revenue cycle management streamlines claims processing to hasten this patient payment process. Additionally, patients will be aware of their initial out-of-pocket costs thanks to the increased emphasis RCM places on front-end tasks like confirming insurance eligibility. By doing so, providers can prevent any hiccups during the collection of the last payment.

Review of medical services – Care providers are encouraged to analyze clinical treatment data by comprehensive revenue cycle management. By analyzing this data, providers can pinpoint the key points in the cycle where mistakes are occurring and find opportunities to reduce costs. As a result, this will boost provider income and enhance the patient experience.

What are the key benefits of Revenue Cycle management?

To help providers avoid delayed or lost revenue, effective revenue cycle management makes sure that these steps are carried out completely and accurately.

Detecting and Correcting Errors

Healthcare providers can more easily spot where errors are happening in the revenue cycle by implementing RCM. This reduces the possibility of claim denials since 90% of claim denials are brought on by easily fixable technical problems, such as missing data from the patient’s chart or incorrect coding.

When these mistakes are prevented and claims are accepted after their initial submission, providers quickly get paid for their services. Additionally, they don’t have to spend additional funds on research or an appeal of rejected claims.

Reducing Administrative burden

Keeping claim denials to a minimum also reduces the administrative burden. More time and energy can be devoted to patient care when administrative staff members are relieved of the burden of investigating and appealing denied claims.

Additionally, interactions between administrative staff and patients are made simpler by RCM’s careful attention to front-end tasks. For a better overall experience, appointment scheduling, intake form completion, and payment processing are all streamlined.

Keeping Healthcare Fraud at Bay

The prevention of healthcare fraud and abuse is another important advantage of RCM. Every year, healthcare fraud costs the sector billions of dollars. A provider may lose revenue and reputation as a result of a fraud investigation.

Healthcare fraud investigations may result from incorrect medical coding, whether it was done on purpose or not. Among the frequent coding mistakes are billing for:

• Non-performance of services
• Medically pointless actions
• Services rendered by a worker who wasn’t properly supervised or wasn’t qualified
• Poor quality tests or procedures

Providers are much less likely to submit inaccurate information to insurance companies (if at all), thanks to revenue cycle management’s focus on precise data collection, billing, and coding. Additionally, RCM can keep providers abreast of constantly evolving healthcare regulations so that unintentional fraud never becomes a problem.

Medical fraud

Healthcare fraud can also come from dishonest patients. This may occur in one of two ways:

Giving false information – A patient may give false information about their insurance coverage in order to receive treatment for which they would not otherwise be eligible. However, one of the initial steps in revenue cycle management is insurance verification. This implies that administrative staff will immediately notice any incorrect insurance information.

Committing medical identity theft – The healthcare sector is increasingly concerned about medical identity theft. This way, both its victims and its providers pay a price. Since the first step in revenue cycle management is to confirm a patient’s information, any identity theft will be identified and dealt with early on.

During the pre-authorization stage of the revenue cycle, medical providers can also take additional steps to confirm a patient’s identity.

Increasing the revenue of healthcare facilities

Healthcare providers can quickly get paid for their services by avoiding technical errors, claim denials, and fraud investigations. Additionally, they can avoid shelling out thousands of dollars to fix mistakes, contest claims, and look into fraud. Moreover, providers are able to make investments in patient care thanks to their increased income.

Final words

The patient comes first in RCM’s effort to increase provider revenue for all parties. Besides, revenue cycle management company in taxes reduces the amount of time needed for administrative and clinical tasks while increasing provider revenue.