As we’ve researched for our recent 2014 Revenue Cycle Management (RCM) Report, we have been investigating the various uses and audiences that profit from the use of the RCM software. We’ve found that while the value of the technology is obvious for any business, in some industries the features and functionalities have an especially dynamic effect. For that reason, next year we are preparing a special report geared towards the use of RCM technology within one industry in particular—healthcare. This post will preview the contents of the 2015 RCM for Healthcare report by will be taking a look at what makes RCM so vital for the healthcare industry.

Organizations in the healthcare industry face challenges in their business processes that many other companies do not have to deal with. For these institutions, the risks of health and expense are often very high, and everyday business processes must be carried out with extreme precision and control. For that reason, many RCM providers have devoted their expertise to developing solutions specifically equipped for hospitals and other health service institutions. These functionalities include contract management and revenue cycle management that take into account the diverse range of standards and regulations required in the healthcare industry.

There are several key drivers in automating health care procedures. These include reducing wasteful manual processes, speeding up processing times, and increasing savings, but because of the healthcare industry’s specific setup, they are certainly not limited to that. RCM solutions are where the healthcare industry really draws its value from back-office automation. The process of managing revenue is a complex and time-sensitive matter for the health service institutions—one that has become increasingly dependent on the efficiency of technology. RCM solutions are designed to handle the unique billing interaction between health care facilities and insurance companies or patients—an interaction in which claims can be contested and denied, and unfulfilled payments can bring harm for hospitals and patients alike.

For example, healthcare services payment terms are often pre-nogiated with insurance companies, and these companies are careful to only pay for the exact expenses reported. If the medical expenses go beyond these terms, it can mean loss for the healthcare provider. Besides the fact that getting paid is different for the healthcare industry, there are also different types of paying institutions. The costs of medical expenses may be paid for post-treatment by institutions like Blue Cross, or they may require pre-payment approval from private health insurance companies, like Aetna. In either case, the focus on accurate information and controlled processes remains.

In addition, if the patient doesn’t have health insurance, the process becomes a lot more difficult. In fact, loss is a common occurrence for healthcare providers when dealing with both patients and insurance companies, and in order to minimize leaky cash flows, these companies must tighten their controls on remittance data and contract management. A lot of medical practice income is lost because of administrative errors like under-coding or missing charges, and most physicians don’t collect 100 percent of their billables due to these errors and poor collection strategies.

It’s up to a secure RCM system to ensure that all parties as satisfied in health service payments. In an automated procedure, forms are processed electronically and automatically filed in designated sections of the patient’s electronic record. Streamlining the chart assembly process accelerates the coding and billing cycles, while allowing assembly staff to focus on additional value added tasks. When patient information is stored and managed electronically, it ensures swifter and consistent payments, and more data accuracy. In addition, an automated data storage and RCM system reduces denials, and lowers the amount of time spent on processing claims or learning codes and regulations.

Next week, we continue exploring RCM and healthcare by looking more closely at the various ways RCM solutions bring secure automation to healthcare processes.