Revenue Cycle Management (RCM) is the financial backbone of healthcare in the US. Through this process, healthcare providers manage the various financial and administrative processes involved in a patient’s journey, from scheduling an appointment, checking coverage eligibility, patient receiving the medical service, billing, and receiving payments from health plans. The volume of resources that are utilized for this can be imagined by considering the market size of the US revenue cycle management. As per a report by Grandview Research, the market was valued at USD 140.4 billion in 2022 and is expected to expand at a compound annual growth rate (CAGR) of 10.3% from 2023 to 2030[1].
RCM might be perceived as primarily focused on the financial aspects of the business, but in execution, it boils down to making sure patients are cared for at every step of the way. In this article, we discuss how RCM and patient satisfaction are related and how we can optimize RCM processes to provide the highest patient care and experience.
How RCM Processes Impact Patient Satisfaction?
The impact of Revenue Cycle Management on patient satisfaction is significant and multifaceted:
- Impact of Clear and Timely Communication on Eligibility Verification: When a provider is able to verify eligibility for the required medical service in a timely manner, with complete clarity on inclusions and benefits, it would definitely add to the patient's experience in a positive manner, when compared with a delayed verification that can lead to patients getting impatient and negatively impacting their experience.
- Efficient Appointment Scheduling and Demographic Entry: RCM involves the process of scheduling appointments for patients for their requested medical service. Efficient scheduling, which often involves some form of automation, makes it seamless and faster, impacting patient satisfaction positively. Moreover, at the time of scheduling the demographic entries also need to be shared correctly to support the eligibility verification step of RCM. If patients are given an easy and fast way to provide the details, it means lesser errors in the details shared, lesser errors in verifications and faster resolution for the patients so that they can receive the medical care at the earliest.
- Accurate Billing Processes leading to Patient Satisfaction : RCM ensures all necessary documentation is attached to claims, preventing rejections due to missing information, and causing any chaos or confusion between provider and patient regarding payment or co-payment, lack of which can severely affect a patient's experience negatively.
- Inaccuracy in Medical Coding and CDI leading to Negative Impact on Patient Care: Medical coding errors can lead to misdiagnosis, inappropriate treatment, and delays in care. Inaccurate coding can prevent healthcare providers from accessing vital patient information, potentially resulting in medication errors or allergic reactions. Likewise, Clinical documentation improvement (CDI) scrutinizes a patient's health records to identify gaps and clarify the scope of medical services provided. By ensuring accuracy, precision, completeness, and consistency in documentation, CDI helps create a more circumspect view of the patient’s health status.
- Impact of Credentialing on Patient’s Perception and Safety : Credentialing builds patient trust by confirming provider qualifications, fostering satisfaction and stronger relationships. Patients feel reassured when providers meet rigorous standards, enhancing care satisfaction. Credentialing ensures safety through verifying licenses and training, bolstering confidence in care quality.
- Referral Management can Ensure Timely Access to Specialty Care: Its primary objective is to enhance communication between primary care physicians, specialists, and patients, streamlining the referral process. Referral, initiated by the primary care physician, directs patients to specialized physicians or facilities for specialized treatment. A well-designed referral management process not only improves communication but also boosts patient retention rates significantly.
Strategies for Improving Patient Satisfaction through Efficient RCM Processes
How to Optimize RCM Processes for Patient Satisfaction
Improving patient satisfaction through Revenue Cycle Management (RCM) involves implementing strategies that prioritize transparency, efficiency, and patient-centricity in financial processes. Here are some key strategies to look out for:
- Invest in Technology: Implementing advanced RCM software and systems automates repetitive tasks, reduces manual errors, and enhances efficiency. Such technology also includes features such as online appointment scheduling, bill payment portals on easy-to-use mobile applications empower patients to manage their journey conveniently, contributing to overall satisfaction.
- Staff Training and Education: Equip staff with comprehensive training on RCM processes so that there are lesser errors especially in processes like eligibility verification and billing. It not only allows providers to keep a healthy cash flow and revenue cycle, but also allows providers to build a relationship of trust.
- HEDIS for Performance Monitoring: Utilize data analytics tools to track key performance indicators related to revenue cycle management and patient satisfaction. For instance, The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by 90% of America’s health plans to measure performance on important aspects of care and service. The data collected through HEDIS provides information regarding customer satisfaction, specific health care measures, and structural components that ensure quality of care. Identifying trends, bottlenecks, and areas for improvement enables proactive interventions and continuous optimization of RCM processes.
- Build trust with accurate Credentialing: Credentialing is a critical part of RCM. It is the process where insurance companies ensure physicians meet clinical care standards by verifying education, affiliations, licenses, certifications, and training. Moreover, it ensures there's no history of malpractice or adverse clinical incidents, giving patients confidence in the quality of care they will receive. This process has been placed in the system to endorse patient safety and quality of care. When done accurately, it leads to more trust between the patient and the provider.
To sum up, it's critical for healthcare organizations to excel in both Revenue Cycle Management and patient satisfaction. When they focus on being efficient and putting patients first in their financial processes, it's a win for both the providers and the patients. Patients feel satisfied with their experience, leading healthcare organizations to have a stronger bond with patients, a better reputation, more loyal patients, and an increased number of new patients to their healthcare center through word of mouth, ultimately growing the business in a steady and sustained manner.
If you are a healthcare professional and wish to discuss how to optimize revenue cycle management for your organization, feel free to write to us at partnerships@homrcm.com
[1]Revenue Cycle Management Market Report
Bring a change to your Healthcare Operations
A partnership with HOM gives you an inherent:
Adherence towards federal, state, and organizational compliances, as well as safeguarding patient data.
Sense of ownership and commitment towards providing value.
Focus on speed, accuracy, efficiency, and optimal outcomes.
Sense of security and transparency through periodic reporting and actionable insights.
Connect with our experts for a quick analysis and possibilities.
