Hospitals on average miss out on 15% of Medicare billings due to misclassified DRGs or inter-facility transfers that appear as discharges. These billing misses equate to lost revenue to the hospital for which
Revenue cycle management (RCM) is the process of managing and optimizing the financial aspects of healthcare services, from the initial point of contact to the final payment received. The goal of RCM is to improve the revenue and profitability of healthcare providers by streamlining the various steps involved in the patient care cycle. This can involve everything from correcting misbilled care codes to improving collections with patients and insurance providers.
Executing world-class revenue cycle management takes the full alignment of the hospital team - from the intake team capturing the right patient data to providers properly classifying treatments to the accounting and finance team billing against those codes.
Auditing historical revenue for gaps can reveal unbilled treatments or additional avenues to bill for uncollectable payables. In many cases, RCM auditors can reveal past patient events which can still be billed to insurance (especially Medicaid and Medicare). Additionally, optimizing RCM procedures can reduce missed billings or uncollected bills in the future.