COGNEESOL REVENUE CYCLE MANAGEMENT A PROFIT-DRIVEN APPROACH FOR QUALITY PATIENT CARE Cogneesol RCM Revenue Cycle Management Healthcare revenue cycle management is a financial process that medical professionals utilize to manage their administrative and clinical functions related to claims processing, payment and revenue generation. This process incorporates the management, identification and collection of patient services revenue. “If you’re bringing in a certain amount of revenue, you can’t have expenses that exceed that revenue. It seems very basic but people don’t look at it that way.” Cogneesol OVERVIEW OF RCM Pre Claim: This involves the creation and management of patient files, contract negotiation, and verify patient enrollment. Front-End: Everything that occurs before and immediately after the appointment of the patient. This comprises scheduling and eligibility verification through treatment and payment arrangement. Transaction: Submitting the claim to the insurance service provider by using any mode like email, cash or electronically. Back-End: Everything that occurs before and immediately after the appointment of the patient. This comprises scheduling and eligibility verification through treatment and payment arrangement. With this RCM process, other tasks like reporting and analysis, compliance, and quality management are frequently being executed. "Global Healthcare Revenue Cycle Management Market is predicted to grow at a healthy CAGR of 12.2% during the forecast period and is estimated to reach USD 43,500.0 million by 2027." Cogneesol RCM is a significant part of the Healthcare Industry Healthcare organizations need to have policies & practices in place for remaining financially stable. This is where revenue cycle management come into play allowing healthcare professionals to operate foolproof on a regular basis "As per the survey conducted by Black Book Research, 92 % of hospital CFOs relocated their strategic focus to revenue cycle management technology and vendor selection, last year in response to decreasing healthcare reimbursements." Benefits of RCM • Allow you to improve patients care by simplifying the billing & collection cycle. • With RCM, communicating with EHR & accounting system becomes easier. • Bridge the gap between business and clinical sides of healthcare. • It makes all the information available that helps to avoid revision or resubmission of claims. • Helpful in analyzing the revenue goals. • Helpful to identify the loopholes by generating reports correspondent to billing data. Challenges RCM is Facing Today Cogneesol Every clinic face challenges so to overcome them it is required to tackle with the latest approach. The old concept of billing and coding is changing and tending to move towards automation. As it becomes the obvious condition because some of the specific gaps or mistakes in revenue cycle can negatively impact the profit driving activities like: • Claim Submission • Outstanding Accounts Receivable • Failure to review EOBS for denials • Registration and Verification "Fifteen cents of every US health care dollar is spent towards revenue cycle inefficiencies." Processes are becoming more automated and complex. Thus,the evolution came up with a number of challenges for every medical practice so, the practitioners need to consider: Maximize Performance: Declining reimbursement and rising costs mean practice need to capture every earned dollar. Minimize cost: Payment per claim is flat if not declining, and RCM costs are only increasing. Compliance: More complicated than ever and with higher stakes. Business Intelligence: Increasing the need for sophisticated data to drive business. Cogneesol Integration: RCM platforms rely on an expanding ecosystem of technologies that have the function in tandem. Migration to Value-Based Reimbursement: New RCM processes are different from Free-For-Service. Direct patient payment: With the increasing costs of health insurance, this is the large source of revenue. Staff recruitment and relation: It’s harder to find and keep talents. It is very much imperative for any system to understand that the key factor for outsourcing is not only the technology used but the personnel who coordinate and control the software and system. The process is too complicated that can’t be relied fully on technology but gives the privilege to staff to devote more time on highvalue tasks by automating the non-core activities. "The amount, $ 2.7 trillion has been spend annually on healthcare industry by the country, of which $ 400 billion is spent on claims processing, RCM, billing, and bad debts." Key RCM Elements to Measure Effectiveness Revenue Cycle Transformation: End-to-end people, processes, and technology can be optimized to accelerate cash, automate processes and improve operating margins. Rapid Response: Rapid assessment and implementation helps to build a roadmap for a long-term improvement. Referral Management and Patient Access: Reduce patient leakage, secure coverage, improve pre-service collection and prevent denials and write-offs. Revenue Integrity: Improve charge capture, revenue reconciliation, and clinical management. Operational Consolidation: Create or refine shared services to reduce cost and enhance the patient financial experience. EHR Optimization and Conversion Readiness: Optimize existing EHR architecture and evaluate conversion plans to reduce costs, increase revenue and limit go-live disruptions. Cogneesol Cogneesol Why should you Outsource your RCM? It’s a culture change not just a change in the process When RCM was a simpler process it was led by only smaller teams with specialized skills. Owners relied upon the individual skills, the perceived “best” practice was having a strong biller who could find profit within the billing cycle. As businesses developed the complexity also raised, this work culture proved to be inconsistent. The industry recognized that outsourcing this work can help in making cycle seamless and more profitable. • Claims processing shifted from a human activity to a technology-driven process assisted by humans. • Technology requires capital, whereas an outsourcing firm that already have various tools as they have many clients. • Technology requires integration and management, and an outsourcer can hire the right talent to manage it efficiently. • Repeated process leveraged by technology can drive more profit for businesses Find the right revenue management service partner who can help you with: • Saving your time, • Improving cash flow, • Remaining compliant and • Improving staff satisfaction Collaborate with Cogneesol Insight-driven healthcare data is the foundation of effective, efficient and affordable healthcare services. That’s why most of the leading names choose Cogneesol, by considering our proficiency in handling healthcare revenue cycle services. It becomes highly vital that you should have an better revenue cycle management process. How do we help you? • Enhance cash flow • Streamline operations • Quick revenue insights • Continuous monitoring of crucial revenue cycles Our Revenue Cycle Management encompasses • Admission and registration with insurance verification • Patient admission/registration and patient visit management • Clinical documentation • Medical coding, patient health information entry, and management • Medical billing • Patient’s accounts management GLOBAL PRESENCE CANADA U.K NEW YORK INDIA AUSTRALIA Get In Touch United States of America Phone: +1 646 688 2821 United Kingdom Phone: +44 203 371 7486 Canada Phone: +1 905 487 8562 Australia Phone: +61 286 078 983 Email:info@cogneesol.com Website:www.cogneesol.com
