How Can Healthcare Providers Improve Revenue Management

Many healthcare providers operate with minimal resources. Moreover, a lot of the staff are responsible for several different tasks, making it nearly impossible to keep track of everything. Many billing issues are caused by human error, including potentially serious data entry mistakes. One of the main causes of these mistakes is the fact that healthcare providers very often rely on inefficient manual processes. This is why successful healthcare providers use a revenue cycle management (RCM) software tool in order to streamline the complicated billing process.

Managing Revenue

The revenue cycle starts as soon as the patient makes an appointment at the clinic or hospital. From then on, the healthcare provider keeps track of all the financial elements of the care given using robust revenue management software solutions.

Revenue Management For Healthcare Providers

Let’s take a closer look at all the steps involved in a successful revenue cycle management in healthcare process:

  • Claim Preparation: A clinic first needs to collect the patient’s personal data, in order to establish the scope of the insurance coverage. 
  • Managing the Claim: Once all the relevant data is gathered, the claim is sent to the insurance company. Then, the healthcare provider communicates with the insurer to determine levels of coverage.
  • Collecting Payment: Once reimbursements from the insurance carrier are obtained, the healthcare provider sends an invoice to the patient in case there’s any outstanding debt. 
  • Review: The last step entails that hospitals or clinics assess their quality of care in order to find ways to improve treatments more effective. 

As demonstrated, the entire revenue cycle is a very lengthy and complicated process that can result in mistakes and delays.

Medical Codes

Medical codes contain reports from doctors that may include things such as a diagnosis or a surgical procedure carried out by the healthcare provider.

Manual Processing is Still A Problem

Manual processes are one of the main drivers of inefficiency in medical facilities. 

The problems created by manual processes are made worse by the fact that insurers often make changes to their terms. 

How to Optimize Revenue Cycle Management

Compliance software solutions that are powered by business rules (conditional if-then statements that optimize business processes) approve claims before being sent to insurers, which dramatically reduces the number of denied claims before they are submitted to insurers.

Determine Coverage with Automated Processes

Many hospitals and clinics need authorization for procedures, treatments, and medications. 

Rules-powered software tools can carry out prior coverage eligibility tasks virtually in seconds. 

Revenue Management with Rules Engines

A business rules engine is a powerful piece of software that works under the hood of the most powerful revenue management platforms.

These software platforms offer a smooth patient journey by automating repetitive and time-draining tasks. By cutting down on the amount of time it takes them to finish approval and eligibility screening, hospitals and clinics can divert their attention to other critical tasks.


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