RCM Services for Rural Hospitals: Revenue Cycle Management Done Right

According to Health Resources and Service Administration, over half of the health centers in the United States are rural hospitals.

Rural hospitals offer emergency medical, outpatient, and inpatient services to those in rural communities. Most of these hospitals already struggle to provide quality care and collect revenue from services rendered; now, they’re facing even more challenges amidst increasing demand for healthcare services.

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What Is Revenue Cycle Management?

Healthcare RCM (Revenue Cycle Management) involves overseeing healthcare providers’ revenue cycle and preventing delays that result from revenue collection leaks. The RCM procedure begins immediately when a patient schedules a visit and ends once they submit final payment for the care provided.

The goal of rural hospital RCM services is to generate revenue for those health centers. RCM technology incorporates administrative data like personal details of the patient, treatment codes, insurer information, and financial billing details.

With a reliable healthcare RCM service provider, the revenue of your health center will be appropriately managed, thereby generating more revenue and eradicating typical medical coding and billing concerns.

As a result, your health center will have adequate funds to purchase essential medical supplies, equipment, pay salaries, and perform structural improvements.

Of course, a rural health center exists ultimately to save lives, treat patients, and help them recover the best they can. But if there are holes in the revenue cycle management process, then achieving this goal becomes almost impossible.

Typically, any health center must have an administrative department that oversees the medical billing process, but an in-house team alone doesn’t guarantee that revenue cycle management will be done right, especially if they’re not trained properly (a frequent mistake for rural hospitals). This creates the need to outsource professional medical billing services to support your in-house team and help your health center succeed.

How RCM Works in Rural Hospitals

A report from Sage Growth Partners claims that bad debt for over one-third of health centers exceeds 10 million US dollars, and things continue to get out of hand due to unpaid (or underpaid) bills amounting to at least $125 billion every year.

When it comes down to it, rural hospitals have the highest unpaid bills. This is truly due to the fact that they’re facing an uphill battle. They often have to rely on dated methods and software, and many rural hospitals struggle to attract top talent so they can provide optimal care. As a result, these rural hospitals get less profit, have frustrated staff, and struggle to get what they need in order to provide their patients with quality care.

To save your rural hospital from a worse situation, seeking the support of medical billers is the best option. Not only can they help bring your medical billing and coding up to date, but they can also help you collect the revenue you’ve been missing out on. When you have more of the revenue you’ve earned, it’s easier to bring your healthcare center up-to-date, which can have a positive impact on both staff and patients.

Typical RCM Challenges Faced By Rural Hospitals

Many healthcare providers in rural hospitals work hard to offer quality care, but the lack of vital financial automation tools and limited resources push them to rely on dated methods, including dated revenue cycle management techniques that make it difficult to record costs, disbursements, and revenue. As a result, rural hospitals that are determined to get back on track are turning to professional healthcare RCM services to revive and automate the process of revenue collection.

It’s not just an ineffective and inefficient RCM process that can sabotage a rural hospital’s finances. There are many other challenges in rural hospitals, including:

Shortage of Qualified Personnel 

AAMC (the Association of American Medical Colleges) predicted that the shortage of qualified personnel in the health industry could hit 104,900 by 2030. While the entire health industry is feeling the heat of a declining workforce, rural areas are the most affected. In fact, a large percentage of healthcare providers living in rural areas don’t even work there. Despite populations teeming with serious health problems, rural hospitals simply don’t have the personnel needed to care effectively for patients.

Increased Uninsured Rates 

Most of the people living in rural areas are disadvantaged, and a majority of them cannot afford insurance coverage, let alone the cost of healthcare services without insurance. However, they still need and seek treatment. Yet treating uninsured patients puts a major strain on rural hospitals because they don’t get compensation for the care provided. This further affects their revenue cycle management. 

Value-Based Care 

The value-based care delivery model is the most advocated for in the healthcare industry today. It’s a good model, but implementing it in a rural setting is incredibly challenging. Under this approach, health experts get rewards for helping their patients to recover and improve their health, reducing the impact of chronic diseases. But this needs the use of modern equipment and software, which is lacking in rural hospitals. Specialists are also needed in this case, and there are few in these hospitals. Therefore, the implementation of value-based care is a tough task.

The Importance of a Good RCM Process

Baby steps can help rural hospitals improve their RCM, and ultimately, increase their profits and provide better care. The best place for them to start is with a proper RCM process. 

A suitable medical billing process involves 5 phases:

Patients get into the system, and patient insurance and billing information is collected in order to determine eligibility for services. Patients should be informed of cost at this point, whether they do or not do have insurance.

Payment should be captured once services are rendered. If a patient has insurance, a billing code is assigned to the insurance claim. If a patient does not have insurance, then payment should be collected in full, or a payment plan should be put in place.

The submission phase quickly follows, where the claim is submitted to the insurance payer. Proper submission of a claim ensures timely payment, which is why many facilities choose to rely on medical billing and coding software.
This is when the provider gets paid, either by the insurance company, the patient, or a combination of both.
Payment should be collected in full here, and the claim should be closed. However, sometimes claims go wrong, and you may have to start from the beginning to ensure full payment.

Improve Profits for Your Rural Hospital with Professional RCM Services

With a professional medical billing and coding provider, you can double or triple your rural hospital profits. That’s because expert RCM services shoulder all of your RCM activities, including billing, registration, reimbursements, check-in, and outpatient services, and more. You’ll get time to offer quality patient care and enjoy timely repayments. Moreover, you’ll experience fewer interruptions in your cash flow, helping your rural hospital to achieve stronger financial performance.

All health centers experience difficulty collecting payment at some point, but rural hospitals tend to see the most of this struggle, which is typically no fault of their own — just a reality of their location. It doesn’t have to be this way, though, and investing in healthcare RCM services can ensure you maximize collections and revenue for your rural hospital. To get started, reach out to our team today.