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Can A Pharmacist Have Influence in RCM System?

Author: Preetika Biswal

INTRODUCTION

Revenue Cycle Management (RCM) is a system which gets the business and clinical aspects of healthcare under one umbrella. It provides facilities which helps in tracking all the data from day 1 that is from registration to final payment of a balance.

RCM System in lay man’s term revolves around 3P’s ( Patient ,Provider,Payer)

RCM systems helps in verifying patient’s eligibility and benefits to certain services leading to its validating and claiming for payments.

REVENUE CYCLE

The revenue cycle is a collaboration of all the administrative and clinical functions that unifies the efficient working of a company by have an account of all data which helps in managing and collection of patient-related revenue.

There are several steps included in this system like

1. Charging capture
2. Claim submission
3. Coding
4. Patient-related claims and demographic details
5. Pre-registration
6. Registration
7. Remittance processing
8. Third-party involvement
9. Utilization review

FACTORS INVOLVING IN REVENUE CYCLE MANAGEMNET

Any financial-related or revenue management strategies are influenced by internal and external factors.

The internal dynamics are comparatively easier to handle and identity such as patient volume and the charges of the services provided by the organization whereas the external factors create a certain level of difficulty since these factors are much more difficult to track down like the fee payment and claim reviews by the payer companies that is insurance companies.

The claims done by the patient, as well as the payer, needs to be thoroughly reviewed by the provider since the smallest mistakes usually leads to big losses.

The efficacy of such systems to be improved by keeping a keen eye from very start of the process that is during the time of collecting data, the appointments made should be properly accounted and thus seen no loss is made.

‘Time’ is usually the biggest resistance faced during such process thereby a quicker and smarter way calls for attention. Use of scheduled timetables would definitely results in profits and reduce the workload as the schedule could be highly optimized during the working days.

WHY RCM MANAGEMENT SYSTEM?

These systems are on a rise and gaining popularity due to the immense benefits and the efficiency of output produced by them.

Providers usually make sure to make a buy and deploy such systems to store and manage patient’s records.

Various new developments in these systems are helping in easier accounting of details from patient’s complete demographic detail to final payment made by the patient.

RCM integrated with EHR ( Electronic Health Record ) , RCM with Cognitive computing, RCM with Robotic Process Automation and more such developments are being done in these systems

Each comes up with their own benefits like RCM with EHR help in reducing the amount of time between provider and payer , RCM with Cognitive computing establishes surety of correct medical codes associated with the respective patient while RCM with Robotic Process Automation is seen to increase the rate at which the process is being conducted.

RCM Systems are laying a foundation for providing s smarter and effective method of service providing by focusing more in patient-orientated problems and collecting a more detailed notes at the population of patients who are in need of care.

Recent studies have also shown RCM systems have been helpful in tracking and analyzing patients suffering from chronic diseases and helped in monitoring and pinpointing out the abnormalities showcased by the patients.

Several companies and vendors have been providing these services and have shown spectacular results in practice. RCM management being dual in its nature as shown beneficial impacts on both the business side and clinical aspects making it very obvious choice to be followed by any providers. The more efficient is the working of the management systems the more greater are the chances of the provider to flourish well.

RCM software use such principles and rules which helps them in keeping up to date with the new rules and regulations or any sort of changes introduced by the insurance companies and payers.

One should be very wise while choosing their RCM Service providers since the rules and regulations in this marketing world keeps changing thereby one should make sure to select which keeps up with such changes and creates less burden on the providers.

These software tend to memorize and remember the audits and bills in accordance to the laws prevailing according to the payer, which results in reduced workload and labor effort.

RCM services helps in creating a code of conduct which helps un minimizing the chances of denials and balancing the claims, it helps in managing the denied claims and “no response” claims, helps in tracking of underpayments and down coding in a precise period of time and more over helps in analyzing the data in a transparent and accessible way.

A PHARMACIST IN RCM ?

A pharmacist could possible have a great impact in RCM Management and services. A pharmacist is well versed with the knowledge and information of drugs and their potential actions, their adverse effects and their therapeutic usage.

Since RCM Services already involves the 3P’s (Patient, Provider and Payer ) it could upgrade itself to 4P’s ( Patient, Provider, Pharmacist and Payer), since pharmacist have a great role in patient’s adherence and pharmaceutical care it could help in creating more value-based reimbursement.

As a pharmacist , it has already established professional relationship with the providers which indeed leads to better understanding of services provided by the organizations. A Pharmacist when comes to medication and providing a better pharmaceutical care could give a better insight since they are also blessed with the knowledge of regulatory requirements, quality control, pharmcovigilance and drug acts . Pharmacist is a known link between patient and the provider, with certain improvements and changes the role of pharmacist could be established in such

systems which would definitely result in positive outcomes

Subjects like basics to coding and medical billing could be added in the syllabus which would not only help in improving one’s skills but also creating better opportunities in career later in future. How one could analyze the data could also be taught as an elective course which would lead to greater understanding of not only the business aspects but also give a broad view of such subjects when applied in living science.

A pharmacist is already known to posses knowledge about the clinical and medical orientated aspects when well versed with some basic ideas of coding and data analysis could be an evolutionary step in such management services.

COMPANIES WITH THEIR RCM SERVICES

McKesson :

One of the largest company providing medicines, pharmaceutical supplies and health products and services in the US.

CERNER:

A company known to provide various health information technologies

MEDITECH:

Sells health IT used in US, Canada and UK

Companies are highly being benefitted if a proper RCM service management is being used thereby in coming times we could see the wonders of efficient RCM services in our healthcare and creating more job opportunities and great scope of development. Involvement and active participation of pharmacists should be encouraged for a more value-based providing services and ultimately benefitting the patient as well as the providers.