Revenue Cycle Management (RCM)
In mature markets such as North America, RCM has become one of the most popular functions for healthcare providers to outsource, mainly due to its critical importance in managing providers’ internal functionalities in an efficient and cost-effective manner1. The market potential of RCM outsourcing in this region is projected to reach almost USD9.9 billion by mid-20162.
Revenue cycle management in the Middle East
In the Middle East, RCM remains at a nascent stage. However, its prospects are bright as the region’s healthcare market holds untapped potential. According to industry estimates, healthcare spending in the wider Middle East and North Africa (MENA) is expected to reach USD144 billion by 20203.
Middle East healthcare market is also evolving with new regulations, laws, systems, processes and financial dynamics, making RCM a cornerstone in the healthcare industry.
At ACCUMED, we serve as your representative, effectively taking the burden off your shoulders by diligently following up claims-related issues with payers. Through our efficient client relationship team, we act as your centralised point of contact for solving RCM challenges.
We support you, as a healthcare facility, in enhancing your financial performance through change management, business process improvement and innovative technology. We are your partner in the preventing fraud and abuse within the system and in ensuring that regulatory compliance requirements are met.
All in all, we help you transition from implementing an extremely time-consuming, error-prone and costly process to embracing one that is more efficient, manageable and financially viable.
As a process, RCM encompasses a series of steps that lead to providers getting paid on time by insurance companies for services they have rendered to patients. For this process to succeed, each step has to be managed efficiently, starting with front-end tasks like appointment scheduling and insurance eligibility verification with the help of professional medical coders and clinical coders. Designing and implementing onsite-services such as a unit dedicated to insurance-oriented patient journey and pre-authorization management represent the first of two phases of RCM.
Pre-visit eligibility check is crucial as this enables hospital staff to collect patient information and verify a patient’s insurance coverage before an appointment. This step not only improves the patient experience during the actual visit, but it also avoids possible billing delays and reduces the volume of denied claims due to insurance ineligibility.
AccuMed supports you in your health revenue cycle management journey by training hospital staff to accurately capture vital information, making sure that bills are prepared in a manner that correctly reflects the services provided. We also analyse these data for medical invoicing, financial, and management reporting in line with ICD-10 and CPT codes.
The second phase of RCM involves the conversion of collected information into a format that can be supplied to payers, using codes for reimbursement processing. This is currently done in the form of electronic claims (e-claims) and involves back-end tasks such as coding, claims submission, payment posting, statement processing and management of denied claims.
Having a cohesive structure in place improves time management, communication, regulatory compliance, and the ability to spot possible coding and billing oversight, allowing providers to maximise revenue cycle opportunities at point of care.
Prior to our entry in the Middle East healthcare market, the legacy billing model, which regional healthcare providers used to manage their accounts receivable, was resource intensive and uneconomical.
As a business process outsourcing (BPO) company, ACCUMED serves as an extension of the providers’ billing department. When compared with running an in-house RCM facility, we can provide our partners access to state-of-the-art technology and highly qualified professionals at a more cost-effective proposition.
We’re not just any medical billing company. By outsourcing your billing functions, operational expenses related to human resources (i.e. staff salaries and benefits), office space, software purchases and upgrades – plus the headache of regulatory and payer compliance – are removed from the equation. So you can focus on offering quality patient care and accelerating your cash flow, rather than engaging in daily billing and collection concerns.
Even providers with the most streamlined billing protocol can experience claims rejection on the first submission. But thanks to our innovative technology and experienced medical billers, we are able to accurately process claims in a timely manner and ensure that rejection rates are within an acceptable range.
Because of our thorough approach in handling billings from the get-go, we are able to maximise reimbursements on claims, reduce the number of denial and rejection rates, as well as shorten the billing cycle.
The graph below is related to a case study involving an ACCUMED partner that continues to benefit from our proven track record in quality claim submissions and denial management. By following stringent data entry and coding standards, we were able to minimise the provider’s rejection rates by as much as 90%.
As the above illustration shows, we immediately improved the provider’s billing revenue cycle. Due to a change in ownership, the provider decided to bring the RCM operation back in-house. However, after comparing performance between in-house versus outsourced RCM services, the provider opted to outsource the billing business process back to us for better control, improved collection and a much higher revenue prospect.
Our expertise enables us to help providers unlock the earning potential of their practice. We can help you analyse your data and add value to your business by identifying missed opportunities that could net you additional income, as well as plug serious revenue leaks, which – when left unattended – may leave your business financially dry.
Combining our highly qualified consultants and our advanced software, we can identify issues, opportunities and trends. Once these concerns have been addressed, we can provide you with analytical tools and help you devise strategies – through revenue cycle management – that you can use to assess your practice’s performance and pinpoint areas where you can capture lost revenue.
All of these value-added benefits are being offered as part of ACCUMED’s cost-effective Contracting and Pricing Services.
MicroMarket Monitor, ( January 2015)revcycleintelligence.com/news/revenue...
BlackBook Market Research (November 2014)blackbookmarketresearch.com/financially-overwhelmed...
Al Masah Capital (April 2014)http://almasahcapital.com/uploads/report...