Revenue cycle management (RCM) in healthcare means a streamlined process of billing and payment collections. To achieve revenue targets, and optimized revenue cycle must feature seamless payment claim processing, medical coding, charge capture, payment posting, explanation of benefits (EOB) reconciliation, denial management and account receivable services. The revenue cycle workflow starts from the patient’s billing and finishes with the reimbursement of claims.
Future of healthcare revenue cycle management
The healthcare revenue cycle management market is experiencing extraordinary growth due to various factors. Healthcare organizations, especially small and medium-sized providers are experiencing a decrease in revenue due to the implementation of expensive healthcare technologies, increased operational costs and changing insurance policies. To reduce the healthcare costs and mostly the inability to handle changing dynamics of the market, small providers are selling them off to large groups and big healthcare providers. The demand and adoption of the RCM solutions are due to these factors and are serving as the stimulus behind the current market growth.
Most of the healthcare providers are looking to outsource their revenue cycle to third party RCM solution providers as they are specifically skilled in managing the billing processes and helping providers reach their revenue targets. Most of the small and solo medical practices lack the necessary expertise and resources to manage the collection process and which is further jeopardized by the inability to trace errors.
Errors in medical billing and coding are among the major reasons that cause revenue loss to healthcare providers. Inability to verify insurance eligibility, missing personal health information, and incomplete payment claims are some of the additional reasons for revenue loss. With support from RCM solution providers, more than 90 percent of denials can be prevented and which can significantly improve the revenue prospects of healthcare providers.
RCM solution providers who are using cloud-enabled technologies and are utilizing automation tools are in high demand. Cloud-based solution providers are capturing the maximum market as they are easier to scale up and do not require hefty hardware costs. All the financial data is easily available to both parties and they can access it from anywhere. This flexibility and accessibility of data and the convenient provision of cloud infrastructure, such as storage and easy integration with other systems make it more trending. Healthcare providers demand a revenue cycle management solution that is efficient, affordable and scalable.
Both patients and providers are yielding transparency in billing and reimbursement processes. As healthcare cost is rising it is making consumer of the healthcare services concerned on how the costs would be covered. Government and regulatory bodies are pushing for price transparency and require providers to adopt technologies and solutions that can help their consumers have a clear understanding of their healthcare spending.
The need for price transparency is further pushed due to hot issues such as surprise or out-of-network billing. Entrepreneurs and tech giants are entering the healthcare RCM market with innovative payment solutions.
RCM was considered a group of backend processes where it deals with the preparation of claims, speedy submission, and collection; however, the recent trend has shifted RCM to optimize frontend processes. The shift of focus to front-end processes has further fueled the growth of technology-assisted automation.
A majority of providers are already using clinical technologies, such as electronic health record (EHR) systems, patient portals, online payment gateways, and front desk management services. These technologies are paving the path for automation of revenue cycle management.
According to HTF Market Intelligence, some of the major companies that own the maximum healthcare revenue cycle management market share are Cerner, Mckesson, Quest Diagnostics, Allscripts Healthcare Solutions, Athenahealth, GE Healthcare, Eclinicalworks, Conifer Health Solutions, EPIC Systems, Gebbs Healthcare Solutions, Experian, R1 RCM, Constellation Software, The SSI Group, Nthrive.
Future Growth Prospects
The revenue cycle management market is growing at a fast pace and some of the major consumers are physician practices, hospitals, surgical centers, and ambulatory services providers. Approximately 1/4 of the hospitals, that is around 25.5% of the total healthcare market, lack healthcare revenue cycle management services. The North America Revenue Cycle Management (RCM) Market is expected to reach USD 52.7 billion by 2024, growing at a CAGR of 12.6%.
Healthcare RCM outsourcing
As healthcare providers are struggling with increased costs and lower collections, at the same time the majority of their resources and energies are focused on delivering quality of care they get less time to manage their revenue cycle. So, small medical practices and hospitals are outsourcing revenue cycle management to save time and resources. This is why, the demand for an RCM vendor or solution provider has doubled in the last few years. With the help of RCM solution providers, medical practices are focused on collecting more from patients. At the same time, outsourcing RCM lowers the operational costs, reduces the workload on internal resources, streamlines the claim preparation process and lowers the payment denial rate.
By outsourcing RCM, providers can focus more on delivering and improving the quality of care. They can expedite the claim submission process, achieve smooth cash flow, and reduce errors. Most of the RCM vendors are certified to handle data and have security and privacy compliance which makes it easier for the provider to meet standards without investing their resources in training and certifications.
Outsourcing to a professional RCM provider improves payment cash flow, lowers denial rate, enhances patient satisfaction, and helps providers meet their revenue targets. Sybrid MD can help you meet your revenue targets with streamlined billing, efficient front desk management, and integrated revenue cycle management solutions. We believe that when there is no medical revenue cycle management, 25%-35% of revenue is lost due to improper handling at the front office (missed phone calls, patient no-shows, poor follow-ups and collections). We can help to save from the revenue leaks and get maximum revenue collections.