The need for efficient and effective management solutions in long-term care has become more evident than ever on account of constant changes to Medicare and Medicaid. That is why RCM healthcare software provides such a major advantage. Revenue Cycle Management software is designed to streamline the financial management process in healthcare organizations, including long-term care facilities.
RCM software automates many of the manual processes involved in revenue cycle management, freeing up staff to focus on other tasks. With RCM software, healthcare facilities can streamline their operations and improve the overall financial health of their organization.
The best RCM healthcare software in the market performs the following functions:
- User-defined billing cycles
- Automated contract adjustment rules
- Retroactive processing
- Supporting Medicare Part B Therapy Cap
- Custom Reports
The ultimate goal of revenue cycle management in healthcare is to optimize the revenue generation process and ensure that healthcare facilities receive payment for their services. So it is clearly worth understanding the stages of healthcare revenue cycle management, which are as follows:
- Verify the resident’s insurance eligibility: By verifying insurance eligibility, healthcare providers can avoid denied claims and ensure that the patient’s insurance will cover the services provided. One can gather this information through online portals, phone calls with the resident or family, or in-person verification.
- Obtain pre-service authorizations: Here, a nursing home gets approval from the resident’s insurance company for specific medical procedures, treatments, or services. This ensures that the patient’s insurance will cover the cost of the services rendered.
- Charge entry – coding and billing: Healthcare providers enter the charges for the services provided to the patient during this stage. This includes assigning codes to the services using a standardized coding system, such as ICD-11 or CPT codes. The charges are then submitted to the patient’s insurance company for payment.
- Claims transmission, adjudication, and follow-up: At this stage, nursing home staff transmit the claims to the resident’s insurance company, which will review the claim and determine the amount it will pay for the services provided as part of a process called claims adjudication. If the claim is denied, the long-term care facility may need to follow up with the insurance company to resolve the issue and obtain payment for the services provided.
- Payment posting, reconciliation, and reporting: During this stage, healthcare providers receive payment from the patient’s insurance company and post the payment to the patient/family portal. They also reconcile the payment with the charges submitted to ensure that the payment received is accurate. Finally, they generate reports on the organization’s financial performance, including revenue, expenses, and profits.
In the next section, we will look at some of the benefits one should expect when deciding which RCM healthcare software to use in their facility.
Benefits of Healthcare Revenue Cycle Management Software
While discussing healthcare revenue cycle management software, we looked at RCM healthcare software features that make the billing process more accurate. But what are the challenges that assisted living facilities and other long-term care facilities face during revenue cycle management? Here we will explore such challenges as the following:
- Unstable revenue cycle management policies: Changing healthcare regulations make it challenging for providers to maintain stable revenue cycle management policies. Keeping up with the latest changes in regulations, laws, and compliance requirements can be time-consuming and difficult, which can leave you vulnerable to compliance risks.
- Payment collection challenges: Collecting payments from patients at or before the point of service is a top challenge for many healthcare providers. According to industry research, it takes seventy percent of healthcare providers over a month to collect payments from patients, resulting in budgeting errors and a loss of revenue for facilities.
- Coding and charge capture errors: Coding errors by nursing home staff can result in incorrect claims reimbursements, leading to significant financial losses for the facility.
- Pre-authorization processes: Residents must wait for their health insurance provider to authorize a service before receiving or providing treatment. This delay can result in a significant backlog in the revenue cycle, causing providers to fall behind on payments
- The no surprises act: This regulation protects patients and residents from surprise billing by preventing out-of-network providers from billing patients for more than their in-network cost-sharing amount. This policy also prevents balance billing, which is when a provider bills you for the difference between the provider’s charge and the allowed amount. Providers may have to adjust their revenue cycle workflows to achieve compliance with the surprise billing rule.
Once one has learned to overcome these challenges, one will realize that the benefits of using this technology are nothing short of astounding. Whether you own a healthcare facility or work in one, RCM healthcare software can greatly benefit your facility by solving the RCM challenges mentioned above through:
- Optimized workflows to maximize cash flow: Automated manual processes and streamlined revenue cycles translate to providers getting paid faster and less time spent on collecting payments, thus increasing the overall cash flow. By optimizing workflows, long-term care providers can spend more time delivering quality care to residents while ensuring they receive timely and accurate payments.
- Streamlined processes to lighten staff workloads: Less manual entry means that nurses have more time to focus on critical resident tasks and provide a higher quality of care.
- An enhanced resident experience by improving touchpoints: By providing real-time access to payment information, reducing wait times, and simplifying the payment process, residents and their families have a better overall experience.
- Better claim scrubbing for fewer denials: With RCM healthcare software, healthcare providers can verify patient information, check for coding errors, and submit claims in real time. This elder care software can help reduce the number of denied claims, improve reimbursement rates, and increase overall revenue.
Contact us here to demo our long-term care software with RCM capabilities.
Best Practices for RCM in Healthcare
Assuming you work in a long-term care facility—e.g., a skilled nursing facility—you understand the importance of RCM in healthcare and how it can impact your facility’s bottom line. If your facility has already implemented RCM healthcare software, that means it has already taken the first step in adopting RCM healthcare solutions. Still, there is always room for improvement.
Some of the best practices to implement in a long-term care facility include the following:
- Focusing on front-end tasks: By addressing healthcare revenue cycle management tasks upfront—such as verifying insurance coverage, obtaining prior authorizations, and ensuring that the right billing codes are in place—you can avoid delays and denials in the reimbursement process.
- Establishing an authorization tracking tool: This tool should include a database of authorization numbers and other important information needed for revenue cycle management in medical billing. With an authorization tracking tool, SNFs can quickly and easily access the information they need to process claims accurately.
- Establishing a triple-check process: A triple-check process requires the nurse, billing specialist, and the RCM professional to work together to ensure that all aspects of the bill have been checked and are accurate. By implementing a triple-check process, SNFs can reduce the risk of billing errors and improve their chances of getting paid.
- Analyzing and reacting to data: Long-term care data analytics can identify trends, such as high denial rates, and help SNFs to respond accordingly. By analyzing their RCM data, SNFs can make data-driven decisions to improve their overall RCM process.
Should your facility follow the best practices above—in addition to implementing an effective RCM healthcare software—you can expect increased revenues as well as better resident experiences.
The Keys To Choosing the Best RCM Healthcare Software
As we conclude, it is worth mentioning some of the keys to selecting the best RCM healthcare software for your facility:
- Looking for specialty-specific vendors
- Analyzing the long-term care software vendor’s reputation
- Considering the cost of the RCM software and whether it fits your budget
- Asking for software reviews from your peers.
By following these, you can ensure you are choosing the best RCM healthcare software for your facility: a senior care software that will improve revenue and enhance the resident experience.
For more on recent trends in long-term care, read our blog and subscribe to the LTC Heroes podcast.