The administrative aspect of running a hospital is otherwise known as revenue cycle management services. Without an organized and healthy system in place, the coordination among the different teams in the organization, from the doctors to the nurses, and even up to the administrative staff, are affected. Revising Data Collection The very first step in revenue cycle management is data collection. Setting up the profile of the patient should give the administration a clearer picture of the kind of approach they should have with the patient and their transactions.
Various institutions are studying and looking into certain modifications to the payment terms indicated in the contracts, whether for insurance coverage, co-pay or self-pay. Modifications might also be implemented with data collection, which could possibly help further improve revenue yield, especially since the implementation of the new Medicaid expansion program. Under this new expansion program, the number of enrollees significantly increases, thanks to the lowered eligibility. Now, individuals with annual incomes below 138 percent of the established federal poverty level–$26,347 for a family of three and $15,417 for an individual–are now accepted. Internal revenue cycle drivers that may affect revenue flow involve productivity, patient volume and fees generated. Meanwhile, external drivers include commercial claims and government payers, patient payments and general collections. As for data collection, the Centers for Medicaid (CMS) and their regional offices have made investments to improve the infrastructure for information technology to be used. Whereas the established system is the MSIS (Medicaid Statistical Information System), there will soon be the new T-MSIS (where T stands for Transformed) to be rolled out through different data products by the end of 2016. It will contain enhanced information on beneficiary eligibility, enrollment, claims and managed care data and even expenditure data for Medicaid among others. It is expected that states and territories, most, if not all, will be transitioning to this system as soon as it is made available. Managing Revenue Cycle Making this change and adjustment would require a delicate balance between maintaining the integrity of the current setup, while also slowly introducing and integrating the new system. What is revenue cycle management doing for organizations during a time like this – to make the entire process a lot more convenient and less burdensome on the part of the patients? If your organization is having trouble keeping up with your RCM needs, therefore, you should not waste any time and instead consult with professional service providers like DECO. Entities such as this can help you make that transition and improve not only your revenue management, but more importantly, also your revenue yield. Sources: Definition of Revenue Cycle Management. Chron. Revenue Cycle Management (RCM). SearchHealthIT.