Revenue Cycle Management vs Revenue Excellence

Across the healthcare industry, revenue cycle management (RCM) remains essential to running clinics and hospitals successfully. The revenue cycle continues from the moment a patient walks in to finally billing for service.

Each year, the healthcare market provides varied services to thousands of patients. Regular check-ups, lab tests, complex surgeries and other services are expected. All these services generate revenue, and the service providers, whether hospitals or medical insurance companies, work together to generate revenue. As a result, the RCM market is becoming increasingly crucial for delivering optimal service to patients and boosting revenue.

The size of the global revenue cycle management market was USD 243.1 billion in 2021. Furthermore, it is projected to grow at a compound annual growth rate (CAGR) of 11.6% from 2022 to 2030.

This expansion is driving the growth for changes in revenue cycle management and pushing the system toward revenue excellence.

What is Revenue Cycle Management?

The Healthcare Financial Management Association (HFMA) defines the revenue cycle as "all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue."

The process starts when patients register for a service. It continues when they get access to the service, go through all the administrative procedures and finally make the payment for the service. All the steps in the revenue cycle that are involved in this process to collect the revenue are called revenue cycle management. This revenue cycle keeps track of each step until the final balance payment.

In simple words, the management identifies the source of the revenue and manages the entire process until collection. The system bridges the gap between business and the services of the healthcare industry. It extensively uses administrative data in the entire process.

The data includes the patient's personal information, choice of service, modes of payment, insurance provider details, and other healthcare and personal data. The revenue entirely depends on the type of service the healthcare facility provides.

For a healthcare provider to be successful and ensure that all operations are running smoothly, they need proper revenue cycle management.

Why is Revenue Cycle Management Important?

According to Growth Jockey, successfully carrying out medical practice requires several factors, and RCM is one of the many essential aspects. To avoid economic challenges in the industry, and to ensure doctors, healthcare workers, and all staff in the industry are well reimbursed, advanced management of the revenue cycle is necessary.

Every RCM strategy has three essential pillars that are critical to its success. The pillars of revenue management should focus on people, processes and technology.

• People: The backbone of any organisation across all sectors are the employees that work there. In the revenue management cycle of the healthcare industry, involving the right individuals in the right job can allow smooth management of different aspects of the business.

• Process: There are different processes involved that include registration of patients, medical coding, patient billing, transcription of medical records, allowing services to respective healthcare providers, etc. Following a structure and proper workflow while working can ensure guaranteed results for the RCM system.

• Technology: Access to advanced technology can change the game for any revenue cycle management system. The entire process can benefit from using the latest technology. Whether you need to monitor data, automate processes, streamline workflow, or gather insights, it allows employees to perform complex tasks quickly without using too many resources.

Although RCM primarily targets the industry's revenue growth management, it provides other benefits to both patients and doctors.

Strong revenue cycle management allows tracking and avoiding falling into healthcare fraud. Healthcare fraud is common in this industry — double billing, fake claims, prescription drug abuse, delayed or missed payments, and other scams are not unusual.

It is estimated that nearly sixty billion dollars are lost annually due to healthcare fraud and abuse. A report on the Cost of International Health Insurance reveals that corruption and fraudulent claims are two of the biggest challenges in the healthcare sector that continue to rise.

Increasing the use of advanced technology and AI in revenue cycle management improves performance and paves the way for revenue excellence.

Improving Revenue Cycle Management to Revenue Excellence

Revenue excellence is a multi-step process. It involves everyone from the top tier, including all stakeholders, to all those availing themselves of the service. The stakeholders, administrative staff, finance and accounts team, service providers, and other essential teams must be working together to bring about change in the revenue cycle.

Analytics, technology, revenue channel distribution and management, and marketing strategies — should be a priority. The different steps involved in approaching revenue excellence are discussed below.

1. Setting Up a Revenue-Focused Cross-Functional Ownership

Individuals from all functional areas, including the marketing, operations team, service, and customer success, should work together to manage everything at macro and micro levels. Everyone outside the stakeholders should be consolidated into a centralised team. This gives them a sense of accountability and ensures growth within the organisation.

2. Making Use of Data

The healthcare sector generates a lot of daily data that experts can utilise to set and monitor revenue goals. Not using analytics indicates that the RCM system needs to be revised. Whether you have room for improvement in the strategy, the result yielded by it, or the end goals, generating insights can keep track of these and improve revenue growth.

Generating insights can also reduce fraud claims. The operations and administrative team can view all the information required for the claim, deny specific claims, or revise them accordingly. This also ensures patients using mediclaim have their dues cleared.

Growth Jockey makes extensive use of data to support businesses in coming up with an excellent revenue strategy.

3. Adopting Digitization and Latest Technology

Unnecessary operational steps often obstruct the path of the revenue cycle. Optimise operations and improve efficiency by adopting automation. This allows for simplifying all administrative processes, keeping patient data records, managing incoming patients swiftly, streamlining billing processes, and opening up new potential for the organisation.

As these operations simplify, hospitals increase their capacity for new bookings, which is crucial to revenue growth and business expansion.

The growth of a company starts with revenue excellence. One of the initial steps is to assess the current strategy. Once you identify what is missing, and note the shortcomings, rearrange the strategy to drive performance.

Build A Strong Revenue Cycle with Growth Jockey

Patient care has always been and will always be the top priority for all healthcare facilities. Be it the type of service they provide or the size of the health system, it is crucial to provide patients with the best service to ensure the services continue to expand.

Healthcare facilities must establish a solid foundation to expand their business in these evolving times. Patients are looking for quality service and holistic care. They tend to go to healthcare facilities where they get convenient services like fast billing, online consultation, at-home sample collection, etc. As a result, healthcare providers strive to streamline all processes and evaluate their revenue cycle management.

There are different strategies to bring into the management of the revenue cycle that can boost the facility's revenue growth and push it toward revenue excellence.

Get in touch with Growth Jockey to take a closer look at the revenue cycle management of your organisation. Identify the issues at an early stage and address them to remove any financial obstacles. We guarantee 10X revenue growth by helping you explore new revenue sources, utilise existing sources and improve financial stability.

Since healthcare revenue cycle management is constantly progressing, many organisations need help keeping up with the changes. Getting expert help ensures growth is going in the right direction and organisations experience smooth functioning in every operation. Get in touch with Growth Jockey today!

At Growth Jockey, our unwavering dedication lies in creating customised models that effectively tackle the crucial challenges confronted by our clients across diverse industries. Regardless of the size of your company, whether a small-scale enterprise or a large corporation, you can now leverage cutting-edge technology to drive revenue growth.

Take the decisive step towards unlocking the next level of growth for your brand by contacting us today!