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Key Functions of Advanced Healthcare RCM Solutions


Many health systems have experienced sharp increases in uncompensated care and claim denial rates in recent years, challenges enhanced by the ongoing pandemic and healthcare labor shortage.

As a result, forward-thinking healthcare organizations have re-evaluated their revenue cycle management (RCM) practices in order to not just survive, but thrive. Many healthcare providers have found a scalable, end-to-end RCM service to be the answer.

A comprehensive RCM solution can revolutionize the way an organization manages its revenue cycle through automation and the linking of core revenue cycle processes.

Vital RCM Functions

A proper end-to-end RCM solution unifies people and technology to perform critical functions that include but are not limited to::

Collecting Pre-Visit Patient Data

Gathering patient data prior to an office visit often becomes a redundant task when much of the same information is collected again upon a patient’s arrival at a treatment facility. This disconnect is frequently attributable to a lack of communication between scheduling and registration software.

An advanced RCM solution streamlines the data collection process. It allows component applications to securely share relevant patient information, and it provides opportunities for automation that can accelerate workflow and improve the patient experience.

Eligibility and Prior Authorization Verification

Pre-authorization for healthcare services is crucial for providers and payers.

But prior authorization also benefits patients. More than 90% of patients want to know their payment responsibility before a healthcare provider visit, according to an InstaMed survey.

An end-to-end RCM solution can improve the accuracy and speed of pre-authorization processes through automation capabilities. This further diminishes the risk of claim denials and payment delays, and eases some of the workload burden on internal support staff.

Utilization Review

Utilization review is another task that can be hastened by modern RCM technology. A revenue cycle management solution ensures payers have the details they need to perform utilization reviews so they can promptly process claims.

Medical Coding and Billing Compliance

Medical coding and billing compliance is a concern for healthcare organizations of all sizes, especially as they struggle to maintain pace with claims while coping with the effects of the labor shortage.

Coding errors are a major contributor to claim denials, and they can clog a revenue cycle. Coding and billing issues delay payments, impede staff productivity and tarnish the patient experience. RCM coding and billing technologies are designed to work with healthcare teams to automate certain features, and improve accuracy and efficiency while maintaining compliance with state and federal regulations.

Claims Management

State-of-the-art RCM solutions also feature dynamic claims management capabilities. Integrated technology that spans multiple revenue cycle processes helps reduce initial claim denial rates and assist with submitting timely appeals.

Accounts Receivable Management and Credit Resolution

An end-to-end RCM solution does more than boost the precision and proficiency of accounts receivable (AR) management and the credit resolution process. It also features tools to help healthcare providers gain a better understanding of payer habits so they can forecast revenue streams and implement improved collection strategies.

Reporting and Analysis Features

A truly inclusive RCM solution employs artificial intelligence and advanced reporting and analysis tools that are able to process and give context to volumes of data. Healthcare leaders can leverage this information to identify opportunities for improvement and make confident, knowledge-based decisions.

The Benefits of an End-to-End RCM Solution

An end-to-end RCM service offers advantages in every stage of the revenue cycle, and it should be scalable to meet the changing needs of a provider and its patients. When it comes to deploying an RCM solution, however, there are some pivotal benefits that deserve special attention:

Ease of Integration

Perhaps the biggest shortcoming of legacy RCM systems is that many of them are not capable of sharing data with one another. This creates a data silo that prevents accessibility within a healthcare organization’s various departments.

For example, a physician may not be able to readily review patient data if their system is not linked to the system used by intake personnel. A modern RCM solution facilitates seamless data transfer and communication between multiple platforms and departments.

Cloud-Based Technology

The technologies that drive contemporary RCM solutions are cloud based and eliminate the need for internal installations and updates. The cloud provides swift data parsing and reliable security.

Reduced Medical Coding Errors and Other Data Entry Mistakes

AI-enabled RCM technology allows healthcare providers to automate many data entry tasks, and it can improve medical coding efficiency. Faster claim processing and fewer claim denials lead to speedier reimbursements and increased revenue.

Elevated Productivity, Profitability and Patient Experience

An end-to-end RCM solution eliminates many common revenue cycle disruptors, and it is an ally to often-overloaded healthcare teams struggling to maintain both productivity and patient care. From initial patient contact through treatment and billing, modern RCM services are designed to expedite patient care, amplify billing and payment processes to grow revenue, and let patients move forward with their lives.

RCM Solutions from GeBBS

GeBBS Healthcare Solutions is a leader in RCM services including health information management (HIM), patient contact and extended business office resources.

Our solutions cover everything from scheduling and prior authorization to medical coding and billing to credit balance resolution and beyond. These services are scalable to the unique needs of our healthcare partners, and they deliver measurable results.

GeBBS has earned numerous accolades for its forward-thinking HIM and RCM solutions, including being ranked among Modern Healthcare’s Top 10 Largest RCM Firms, Black Book Market Research’s Top 20 RCM Outsourcing Services and Inc. 5000’s Fastest-Growing Private Companies in the United States. Request a consultation today to learn how GeBBS can help optimize your organization’s revenue cycle.

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