Revenue Cycle Management Software is a financial tool that helps businesses—such as nursing homes, assisted living, and other long term care facilities—manage their finances and keep track of their revenue cycle process. This financial software can be used to track income, expenses, invoices, and anything else related to a business’s finances. Revenue cycle management software is a great help for businesses of all sizes, particularly long term care facilities looking to improve their revenue cycle processes.
Revenue cycle management (RCM) is the process that organizations track and manage their finances. The goal of RCM is to ensure that an organization can generate enough revenue to cover its costs and make a profit. In healthcare, this means collecting payments from patients or residents, health insurers, and other payors for the services that have been provided.
The revenue cycle process begins when a patient receives the care they need in a healthcare facility and ends when the provider is paid. In between, there are a number of steps that must be completed to collect payment. These revenue cycle steps include the following:
- Pre-registration: The process of gathering patient information prior to the provision of care. This step is important to ensure that the correct insurance plan is being billed and that any necessary pre-authorizations for services have been obtained from the healthcare insurer.
- Registration: Here, nurses create a patient record in the facility’s system long term care EHR and assign them a unique identifier. This step ensures that the patient’s record can be easily accessed by all members of the care team.
- Coding: In order to be paid, the provider must submit codes that describe the services provided. These codes are used by the payor to determine how much they will reimburse the provider. Skilled Nursing Facilities (SNFs) that receive reimbursements through PDPM must have an MDS nurse that understands the PDPM ICD-10 Codes to ensure accurate clinical category mapping. Failure to code accurately can result in denial of claims and lost reimbursements.
- Charge Capture: This is the process of creating a bill for the services that were provided to a patient or resident. This bill will itemize the charges for each service provided to the long term care resident.
- Claim Submission: The bill that was created in the charge capture step is submitted to the payor. This can be applicable to the patient or resident, their health insurer, or another type of payor (Medicare or Medicaid).
- Remittance Processing: At this stage, the payor will send a payment or denial to the provider. If the claim is denied, the provider will need to follow up with the payor to determine why the claim was denied and how it can be corrected so that the facility is paid.
- Patient Collections: In some cases, the nursing home resident may be responsible for a portion of the bill. The provider will need to follow up with the resident in order to collect any money that is owed.
- Utilization Review: This is the process of ensuring that the services provided to the patient or resident were medically necessary and met all of the requirements of the payor or insurance provider. The utilization review step is important in order to avoid denials from the payor.
Revenue cycle management can be a complex process, but it is an important part of running a healthcare facility. Revenue cycle management software can be a great help in managing this process and ensuring that a long term care facility is fairly reimbursed for the care they provide. In order for an administrator to choose the best RCM software for their facility, there are some factors that they must take into account.
4 Things to Consider When Choosing a Revenue Cycle Management Vendor
Healthcare providers certainly have options when it comes to revenue cycle management systems. In fact, the great number of nursing home software vendors in the market can make it difficult for a long term care leader to know which software is the best fit for their organization. Here are some key factors one should consider when choosing an RCM vendor:
1. Specialty-specific Solutions
While there are some general RCM software packages on the market, these may not be the best fit for a long term care facility. Long term care providers have unique needs when it comes to revenue cycle management, and it is essential that an administrator chooses a vendor that understands these needs.
A speciality-specific revenue cycle management software will be designed for long term care facilities and include features that are important for this type of organization. For example, a speciality-specific RCM software package may include features that enable the incorporation of MDS coding data, PDPM compliance, and POC CNA Charting. These are important for SNFs, and choosing a vendor that offers these features will make it easier to run a facility’s revenue cycle process.
2. Trust in the Vendor
When it comes to revenue cycle management software, it is important for administrators to choose a nursing home software vendor that they can trust. This includes both the software itself and the company that provides it.
A revenue cycle management software vendor should have a good reputation in the industry and should be known for providing reliable and effective solutions. Furthermore, the vendor should have social proof from references obtained from other long term care providers who use their software.
It is also important to make sure that the revenue cycle management software itself is trustworthy. This means that the software should be designed to meet all of the compliance requirements that are relevant to your facility. For example, in the United States, all long term care software vendors need to be HIPAA compliant.
3. Cost of the Software
Long term care leaders must always remember that revenue cycle management software is an investment, and it is vital they choose a vendor that offers a fair price for their product. It is also important to make sure that the software is worth the initial investment. In other words, administrators must ensure that the revenue cycle management software will actually help save time and money for the facility.
The best way to determine whether a piece of revenue cycle management software is worth the price is to read reviews from other long term care providers who have used the software. These reviews will give staff an idea of whether the software is easy to use, effective, and worth the price.
One should consider the Total Cost of Ownership (TCO) of the software. This includes the initial purchase price of the software, the cost of installation, training, support, and upgrades. Some revenue cycle management vendors may offer a low purchase price, but the TCO of their software may be quite high. Hence, an administrator needs to consider all of the costs associated with a piece of revenue cycle management software before making a decision.
4. Peer Reviews
Finally, it is always important for long term care administrators to consider the opinions of their peers when choosing revenue cycle management software. Other long term care leaders may have already gone through the process of choosing revenue cycle management software and can offer valuable insights. Furthermore, these administrators can provide information about which revenue cycle management vendors are reputable and which ones to avoid.
Hence, it is always a good idea to consult or seek the opinion of other long term care leaders before making a decision about revenue cycle management software. An easy way to do this is by reviewing case studies of other facilities that have benefited from using a particular nursing home software. This not only saves time but also allows an administrator to get accurate views from an industry leader they may not have the opportunity to meet.
Contact us here if you would like to test drive the best revenue cycle management software in long term care.
The Role of a Revenue Cycle Team in a Long Term Care Facility
A revenue cycle team is responsible for the entire revenue cycle of a long term care facility. The team utilizes the facility’s revenue cycle management software to coordinate with all members of the facility, ensuring that the revenue cycle process is as efficient as possible. In order to do this, the revenue management team must have a clear understanding of the facility’s RCM billing software, the long term care EHR software, and the revenue cycle management steps.
A revenue cycle team performs multiple functions in a facility, ensuring that revenue cycle management in medical billing functions as needed. Some of what they do includes:
- Revenue cycle oversight: Revenue cycle teams provide oversight of the revenue cycle, ensuring that all steps are completed correctly and in a timely manner. They also work with facility staff to ensure that they understand their roles in the revenue cycle and how to properly use the revenue management software.
- Workflow documentation: Revenue cycle teams assist with workflow documentation by creating flowcharts or other graphics, depicting process steps, and determining decision points. This helps to standardize revenue cycle processes and improve overall efficiency in the facility.
- Process reviews: Revenue cycle management teams review processes and steps within the revenue cycle to identify opportunities for improvement. This can be done by evaluating procedures or looking at process flowcharts to spot control deficiencies and waste. Reviewing processes on a regular basis is part of a continual improvement mindset, a major concept in quality assurance.
- Staff training and support: Proper training is essential for revenue cycle staff, as they must be able to use the revenue management software correctly to do their job. Revenue cycle teams provide training and support to other financial and clinical staff, teaching them how to use the software and troubleshooting any issues that they may have.
By providing oversight, documentation, reviews, training, and support, revenue cycle teams help to improve the overall financial health of assisted living facilities, nursing homes, and other long term care facilities.
Importance of Revenue Cycle Management Software
Revenue cycle management software helps to automate and streamline the revenue cycle process, making it more efficient and effective. In addition, revenue cycle management software provides valuable insights and data that can be used to improve the financial health of the facility. Other additional benefits of revenue cycle management software include:
- Improved billing efficiency
- Better decision making
- Simplified workflows
- Faster claims and collections
- Robust reporting
Long term care leaders who have not yet adopted a revenue cycle management software that is compatible with their long term care EHR should consider one, as the benefits of the software help greatly improve the financial health of the facility.
For more on recent trends in long term care, read our blog and subscribe to the LTC Heroes podcast.
