Full revenue cycle management (RCM)

Full revenue cycle management (RCM)

The revenue cycle for medical institutions is the most critical aspect of any establishment. The financial returns of the institution rely on the efficiency, expertise, and professionalism of the individuals responsible for managing this cycle. This requires a blend of administrative, financial, and medical skills to ensure the highest quality. It is imperative to avoid any deductions from the rightful financial returns of the institution that might arise due to even the slightest oversight.

This can be achieved through the following points:

1- Administrative review of invoices to ensure the application of all terms and operating instructions provided by the contracting company.

2- Financial review of invoices to ensure the application of discount rates on each item agreed upon between the institution and the contracting company.

3- Medical review of invoices to verify the alignment of diagnoses with the treatments performed for patients in clinics and emergency cases. This includes a final medical report review for inpatient cases, along with a review of all supplies and medications provided to the patient during their hospital stay.

4- Organizing and closing claims according to each company's instructions, making it easy for the institution's invoices to be reviewed within the insurance company.

5- Compiling and submitting all claims to insurance companies within the specified timeframe to avoid delays in review and the resulting delays in hospital funding.

6- Working on collecting the financial amounts due to the hospital from the contracted companies on time, as stipulated in the contract, without delay.

7- Working on reimbursing amounts deducted unfairly from insurance companies and returning those funds to the hospital.