Healthcare companies that boast quick payments, easy patient communication, and efficient billing systems all have one thing in common: they use RCM software.

RCM software is designed to help healthcare providers manage their revenue cycle more effectively.

It does this by automating many of the tasks that are traditionally handled by human employees, such as billing and collections.

This helps to improve efficiency and speed up the process of getting paid for services rendered.

However, not all RCM software is created equal and there are a number of features that set the best RCM software apart from the competition. As with any industry, medical billing and collections professionals know what separates the good from the bad with RCM software.

This article will cover the most important features that should be looked for when purchasing RCM software.

What Does RCM mean?

Revenue Cycle Management (RCM) software is designed to help healthcare providers manage their revenue cycle more effectively. This is done by automating many of the tasks that are traditionally handled by human employees, such as billing and collections. This helps to improve efficiency and speed up the process of getting paid for services rendered. However, not all RCM software is created equal and there are a number of features that set the best RCM software apart from the competition. As with any industry, medical billing and collections professionals know what separates the good from the bad with RCM software.

One of the most important features that should be looked for when purchasing RCM software is its ability to automate and streamline claims management, payment processing, and the overall revenue process in a healthcare provider’s office. This is done by eliminating the need for manual intervention and allowing providers to focus on their core mission of providing quality patient care. Automatic account edits, integrated EMR interfaces, online claim submission, and automated billing are all standard features in the best RCM software solutions.

RCM software can be a big investment for healthcare providers, so it is important that providers do their due diligence when selecting a solution. Not all software can accommodate the unique needs of every provider. A comprehensive review of the features included with each software solution will help providers understand which product best suits their specific needs.

The ability to easily adapt to changing billing and reimbursement requirements is another feature that separates the best RCM software from the competition. Healthcare regulations are constantly changing and it is important for providers to ensure that their provider billing software can accommodate those changes as seamlessly as possible.

What Are The Features In RCM Software?

There are a lot of features in RCM software. The best ones help with billing and getting paid for the services you provide. They also make it easier for you to communicate with patients and to keep up with changing healthcare regulations.

Below  we have listed the most important features that should be looked for when purchasing RCM software:

●  Scheduling and calendars allow providers to easily update and maintain appointment calendars for patients.

●  Secure messaging allows providers to communicate with their patients through a private portal, saving them time and money they would otherwise spend on postage.

●   Integrated EMR systems so that patient records can be automatically imported into the billing system, saving providers time and reducing the risk of errors.

●  Automatic claim edits automatically flag common billing issues which can result in a claim being denied so they can be corrected before resubmission, resulting in a higher percentage of claims being paid on the first submission.

●  Automated insurance eligibility checks that auto-populate eligibility forms on behalf of the providers so they can quickly submit claims for patients who are insured without having to manually check their coverage.

●  Customizable dashboards that provide quick access to key billing data that providers need in order to make effective business decisions, including A/R reports, insurance eligibility status, outstanding balances by

●  Eligibility Management streamlines the eligibility process for both providers and patients to ensure that only those who are eligible receive services.

●  Online claim submission allows providers to submit claims anytime, anywhere, rather than being tied to their office computers. This saves time and reduces the risk of errors.

●  Claim scrubbing features allow providers to search through past claims to identify any potential coding errors.

●  Automated insurance follow-up allows providers to schedule automated emails and phone calls to patients about their outstanding balances following a visit, ensuring that accounts are not left unpaid.

●  Charge and Code editing allow providers to edit claim lines one at a time or batch-edit multiple claim lines simultaneously, reducing the risk of error.

●  Electronic remittance advice allows providers to receive insurance payment details without needing to manually check EOBs. This ensures that claims are paid on time and reduces the risk of having patient accounts sent to collections.

●  The patient portal provides a secure online environment where patients can view account statements and pay their bills online, saving providers time and reducing the risk of patient accounts being sent to collections.

●  Multi-tasking payment posting features that allow users to simultaneously post payments into accounts receivable, insurance, co-pays, and other accounts.

●  Claim Management – Claims can be processed accurately and efficiently – minimizing denials – with features such as auto-adjudication, CPT/ICD coding, and automatic electronic remittance advice.

●  Denial Management – ​The ability to reduce denial rates, improve cash flow and optimize reimbursement

●  Financial Performance – In addition to detailed reporting features that allow providers to compare current performance with budgets or prior periods, providers can get a real-time view of A/R and

●  Patient Collections – Tools that help ensure maximum patient collections, including integrated letters, statements, and patient portal access.

●  ICD-10 compliance – The ability to support the transition to ICD-10 by automatically identifying incorrect codes and enabling providers to correct and resubmit claims in a single, easy step.

Click here to learn more about RCM software services.

Different Revenue Cycle Management Steps

There are several different steps that are involved in revenue cycle management (RCM). The most common steps are as follows:

1. Pre-billing

2. Billing

3. Claims submission

4. Insurance verification

5. Eligibility determination

6. Claim adjudication

7. Payment posting

8. Accounts receivable management

9. Financial reporting

●   Pre-Registration

When a patient first contacts a healthcare provider, the provider should gather as much information as possible about the patient and their insurance. This will help to expedite the administrative requirements later on. Providers can make use of technology to help them gather this information, such as online insurance verification tools.

●  Registration

When a patient first arrives at the office, the staff will collect any outstanding information, such as insurance information and consent forms. The staff will also ask the patient to sign in. This will allow the provider to track who has and has not been seen by the provider.

The staff will also ask the patient to complete a registration form. This form will ask for basic information about the patient, such as their name, address, and contact information. The form will also ask for demographic information, such as their date of birth and Social Security number. This information is necessary to bill the insurance company correctly.

The form will also ask about the patient's health history. This information is important for the provider to have in order to explain it to the insurance company.

●  Charge Capture

When a physician provides a service to a patient, they will need to document the service on a medical claim form. This document will list the services that were provided to the patient and the corresponding CPT or ICD codes. The physician will also need to indicate the date of service, the provider's name, and the patient's name. This information is necessary to bill the insurance company correctly.

●  Utilization Review

Some people think about whether or not a treatment is necessary in order to save money and make people healthier.

This is why some insurance companies have a department that reviews the medical claims submitted by providers. This department will compare the medical services provided to those outlined in your policy and determine if they are appropriate for your condition. The department may decide not to cover certain treatments, even if they were performed.

●  Coding

The staff who are responsible for coding the medical diagnoses and procedures in a patient's medical record use specially trained software to identify the correct codes. These codes are based on the International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT). The staff will also document the services that were provided to the patient and the corresponding CPT or ICD codes. This information is necessary to bill the insurance company correctly. Click here to learn more about RCM training for coders.

●  Third-Party Follow-Up

Revenue cycle management (RCM) is the process that healthcare providers use to track and bill patients for the services that they have received. This process includes several different steps, such as pre-billing, billing, claims submission, insurance verification, eligibility determination, and payment posting. RCM is important for healthcare providers because it helps them to improve their cash flow and ensure that they are being paid for the services that they provide.

One of the main tasks of RCM is to identify and pursue third-party payers. This includes insurance companies, government agencies, and other organizations that may be responsible for paying for healthcare services. RCM also includes the task of collecting payments on behalf of patients. This can be done by contacting patients and insurance providers, helping patients to submit claims, or following up with patients that have not paid their bills.

This process is important for both healthcare providers and third-party payers. Healthcare providers must be able to collect payments in order to stay operational, while third-party payers need to ensure that they are correctly reimbursing healthcare providers.

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●  Claim Submission

When a healthcare provider provides a service to a patient, they will need to document the service on a medical claim form. This document will list the services that were provided to the patient and the corresponding CPT or ICD codes. The physician will also need to indicate the date of service, the provider's name, and the patient's name. This information is necessary to bill the insurance company correctly.

The staff who are responsible for coding the medical diagnoses and procedures in a patient's medical record use specially trained software to identify the correct codes. These codes are based on the International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT). The staff will also document the services that were provided to the patient and the corresponding CPT or ICD codes. This information is necessary to bill the insurance company correctly.

The third-party payer will review the medical claim. The payer may contact the healthcare provider for more information, which can be provided by completing an explanation of benefits (EOB).

●  Patient Responsibility

If a healthcare provider performs a service that is not covered by the patient's insurance plan, the patient is responsible for paying the bill. This may include services such as hospital stays, lab tests, and surgeries. The patient may be able to negotiate a lower price for these services by contacting the healthcare provider directly.

The patient may also be responsible for paying the bill if their insurance company denies the claim. In this case, the healthcare provider may file a lawsuit against the patient in order to recover the cost of the services that were provided.

●  Remittance Processing

When a healthcare provider submits a medical claim to an insurance company, the payer will review the claim to determine whether to accept or deny the payment. There are several factors that the payer will consider when making this decision, such as the amount of the claim, the type of service that was provided, and the patient's insurance coverage.

If the payer denies the payment, they will send an explanation of benefits (EOB) to the healthcare provider. The EOB will list the services that were denied and the reason for the denial. The healthcare provider can then contact the patient to discuss payment for these services.

If the payer accepts the payment, they will send remittance advice to the healthcare provider.

Benefits

Revenue cycle management (RCM) is the process of managing the financial aspects of a healthcare organization. This includes the billing, collection, and payment of services provided to patients. RCM can be done manually or with the help of software.

Software that helps with RCM will automate many of the tasks that are associated with this process. This can include the identification of services that are covered by insurance, the generation of medical claims, and the submission of claims to insurance companies.

The use of RCM software can help your medical practice save time and reduce the number of denials. It can also speed up the process of collecting payments from patients.

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●  Save Time And Effort

The billing process starts with insurance and provider enrollment verification. Revenue management software will help verify this information. The software will also automate the process of submitting medical claims to insurance companies. This can help your medical practice save time and reduce the number of denials.

●  Speed Up The Collection Process

One common method of payment for healthcare services is to bill the patient. The patient will then be responsible for making the payment to the healthcare provider. This may include services such as hospital stays, lab tests, and surgeries. The patient may be able to negotiate a lower price for these services by contacting the healthcare provider directly.

If a healthcare provider performs a service that is not covered by the patient's insurance plan, the patient is responsible for paying the bill. This may include services such as hospital stays, lab tests, and surgeries. The patient may be able to negotiate a lower price for these services by contacting the healthcare provider directly.

The patient may also be responsible for paying the bill if their insurance company denies the claim. In this case, the healthcare provider may file a lawsuit against the patient in order to recover the cost of the services that were provided.

●  Reduce Denials

Software that helps with RCM will automate many of the tasks that are associated with this process. This can include the identification of services that are covered by insurance, the generation of medical claims, and the submission of claims to insurance companies.

The use of RCM software can help your medical practice save time and reduce the number of denials. It can also speed up the process of collecting payments from patients.

RCM Challenges In Healthcare

Revenue cycle management (RCM) is the process of managing the financial aspects of a healthcare organization. This includes the billing, collection, and payment of services provided to patients. RCM can be done manually or with the help of software.

Software that helps with RCM will automate many of the tasks that are associated with this process. This can include the identification of services that are covered by insurance, the generation of medical claims, and the submission of claims to insurance companies.

The use of RCM software can help your medical practice save time and reduce the number of denials. It can also speed up the process of collecting payments from patients.

However, there are some challenges that healthcare organizations face when implementing RCM:

●  Strong Prior Authorization Process

Many insurance companies require that a patient's prior authorization be obtained before the healthcare provider performs the service. This means that your practice must follow up with patients and request this authorization if needed.

If your practice does not properly follow up on required authorizations, you may need to resubmit claims or negotiate with the patient for payment. The cost of these claims will likely be passed along to patients who follow the proper authorization process.

● Slow Processing Time For Claims

Healthcare organizations often experience slow processing times for medical claims submitted to insurance companies. This can cause a delay in receiving payment from insurance providers, as well as the patient's ability to collect on their health plan.

●  Revenue Integrity

The healthcare provider's revenue integrity is another factor that can affect RCM. Revenue integrity is the accurate reporting and collection of claims from patients. Without this, your practice may experience inaccurate billing and increased revenue cycle time.

●  Managing A/R diligently

In order to effectively manage the revenue cycle, you will need to make sure that your accounts receivables are being managed diligently.

●  Credentialing Patients

If your medical practice is part of a larger organization, you may also need to follow referral credentialing guidelines. This can be an added challenge if the primary healthcare provider does not disclose any necessary information related to referrals.

● Expenses Will Continue To Increase

If you fail to properly manage your healthcare organization's RCM process, you may be unable to pay for certain services in a timely manner. This could include anything from an unpaid loan to equipment upgrades. This may impact your business operations and put your organization at risk for closure.

● Decrease In Patient Satisfaction

A healthcare provider that has a poorly managed RCM process will likely experience complaints from patients about billing and payment issues. This can lead to a decrease in patient satisfaction, which can reduce your practice's referrals.

● There Is No Simple Solution To RCM

It is important for you to understand that there is no simple solution to the RCM problems that your healthcare organization faces. You will need to make sure that whatever solution you implement will address all of your organization's needs, as well as reach all its employees.

Final Notes: 

In conclusion, healthcare organizations face a number of challenges when it comes to the revenue cycle management process. It is crucial that you make sure that your facility has access to accurate and efficient solutions for these problems, as well as the time and money necessary to implement them.

The best practices used in RCM software provide an opportunity for healthcare providers to streamline the patient care process. By using these proven methods, you can save time and money while improving the quality of care. If your organization is looking for a way to improve efficiency with better service at lower costs, then contact us today! We have experience working with many different types of health organizations across all 50 states - including hospitals, insurance companies, medical groups, and more. Our team will work closely with you to find out what type of solution would be most effective for your specific needs.

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