4 maja 2022

The Tool for Managing Revenue in the Healthcare Industry

​Many healthcare providers are having a difficult time collecting reimbursements in a timely manner, which may compromise the quality of patient care. It should come as no surprise that many hospitals operate with enough resources. This is why successful healthcare providers are implementing rules-based software solutions to help with effective revenue management.

What is Revenue Management in Healthcare?

Simply put, revenue cycle management in healthcare is the administrative process of overseeing reimbursements from insurers and patients. 

The Steps of a Revenue Cycle in Healthcare

The revenue management cycle for healthcare providers is composed of the following steps:

  • Preparing Claims: To start off, a healthcare provider first needs to determine the scope of the patient's insurance coverage. 
  • Claim Submission: Once all the relevant information has been gathered, a file is then submitted to the patient’s insurance provider.
  • Handling the Submission: The healthcare provider keeps an open line of communication with the insurer in order to fix any potential data entry errors.
  • Reimbursement: Once the reimbursement has been made, the healthcare provider collects payment from the patient, if necessary.
  • Review of the Process: Healthcare providers analyze the treatment process to determine ways of improving the quality of care while cutting down on costs. 

As we can see, the process of managing revenue is involved and time-draining.

Healthcare Providers Are Experiencing Revenue Problems

There are several stages throughout the healthcare journey that can potentially turn into a bottleneck problematic if hospitals and clinics don't use proper software solutions.


Pre-registration is necessary to collect up-to-date information on a patient's history, along with the number of allowable visits, and financial obligations.

Many hospitals make the mistake of not offering payment plans to their patients, which would greatly help patients pay for the medical care they receive.  

Issues with Coverage 

Once a claim has been filed, it’s vital that hospitals regularly touch base with insurance providers. Healthcare providers need to check in with the insurers in order to make sure that all the relevant information has been submitted, and proactively solve any potential issues.

Neglecting to communicate with insurers after a claim has been filed can potentially lead to pending or rejected applications.

Manual Processes Dominate

Manual processes are generally a major reason why healthcare providers are plagued by inefficient reimbursements - they make tasks such as prior authorization arduous and time-consuming.

What is the Major Benefit of Using a Healthcare Revenue Cycle Management Software Solution?

The revenue stream improves because payments from patients and insurers become consistent and expenses are reduced.

Rules-Based Revenue Management Tools

The administrative staff of healthcare providers needs to make sure that their patients enjoy the best care possible while also receiving timely reimbursements for their services. To do so, they need to use robust revenue cycle management tools.

Every powerful revenue cycle management tool has a business rules engine running under the hood. A rules engine uses “if-then” conditional statements to carry out mission-critical tasks like form validation, eligibility screening, and claims handling.

By using a rules-based revenue management software, healthcare providers can provide a seamless healthcare journey by automating long manual processes, enabling them to focus more on providing the best quality care to their patients.

External partner's article



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