Page 17 - HME Business, May 2018

REVENUE
CYCLE MANAGEMENT HITS
HME
Providers are taking a “from the ground, up” approach
to how they manage their revenues. What’s the right strategy? What tools can help?
By David Kopf
YOU’VE HEARD THIS A MILLION TIMES BEFORE: both Medicare and private reimbursement are forcing providers to rebuild their businesses from the ground, up. It’s a concept so
reimbursement sources such as Medicare or private payer plans and then following up with those funding sources to ensure the claims get reim- bursed. RCM is broader. RCM does encompass billing and claims manage- ment, but it also optimizes how claims denial is handled, how patient copays
repeated at industry conferences, in the trade press, and on social
media that it’s starting to sound cliché. However, it’s also true. The question is how do providers build, and where do they start. Smart
business strategists will say that process begins with how they manage their revenue. Fortunately, there’s been a good foundation built in this regard in larger healthcare organizations. Several years ago, entities such as hospitals and health plans started defining and refining the practice known as revenue cycle management, and it helped them optimize, and perhaps revolutionize, their businesses’ incomes.
For starters, RCM is not billing. Billing is the process of filing claims with
are collected, and how much staff time is expended on claims. RCM tracks the revenues and costs related to a patient’s interaction with the health- care organization from the beginning and end of the process. RCM is the umbrella under which all revenues are managed and maximized.
Not surprisingly, a variety of software tools, standardized business processes, and workflows evolved from the growth of RCM within larger healthcare organizations.
And now, RCM has come to HME. In fact, in some ways, it has been here, thanks to the software systems and services that have proliferated in the HME industry. Those systems have helped providers fine-tune their billing
Management Solutions | Technology | Products
hme-business.com | May 2018 | HMEBusiness 17