Excellence in revenue Cycle Management (RCM) is vital to any medical practice’s success. The days of simply submitting an invoice to a healthcare payor and receiving payment has passed. Legal loopholes, procedural drivel, and changing regulations are used by health insurance companies because it saves them money. The payor’s greed can make your RCM management miserable.
A reliable RCM program extends past billing. Your office must capture medical information, provide patient care, service claims follow-up, and collect patient service revenue. From first patient contact to paid claim, RCM management skills are so significant for success, it is critical that you take a hard look at your practice’s ability to maximize your billing cycle.
The Risks of Ineffective RCM
With lack of effective RCM management, a practice faces numerous risks including reduced revenue and sluggish cash flow that includes billing errors, erroneous denials, poor patient retention, slow follow-up, and weak daily collections, all that can destroy a practice.
Billing errors can trigger audits, increase compliance reviews, and result in penalties. When coding or documentation is insufficient, your practice will pay. Higher administrative costs result from an inefficient RCM process.
The work required to reverse rejected prior authorizations and resolution of complicated claims can confuse and frustrate patients. The wait to be paid can change a care plan decision and result in poor healthcare results for patients. A well-trained RCM team and third-party solution experts can improve patient retention and solve many of these common risks to improve your financial bottom line.
RCM Challenges
Many healthcare providers initially attempt to manage RCM in-house, often relying on a few employees to handle billing and collections. Although this might seem more cost-effective, it’s important to recognize the challenges teams face. In-house teams often lack the resources and training to stay up to date with the latest billing trends and technologies. Outsourcing can help reduce risk and ensure billing accuracy.
Healthcare Billing Codes and Constantly Changing Regulations
Many billing codes (CPT, ICD-10, etc.) are continually updated to reflect the latest medical information. There is a constant need for billing staff to stay up to date with coding changes and insurer policies. Even highly experienced experts fight coding errors that lead to claims rejections, delays, and denials. The healthcare industry is heavily regulated, and compliance with the Health Insurance Portability and Accountability Act (HIPAA) and CMS guidelines is essential. Practices also need to stay informed about state and federal laws that influence billing procedures. Without dedicated RCM expertise, these regulations can become a burden, leading to compliance issues, lost revenue, and costly penalties.
Management of Cash Flow and Claims Denials
Successful RCM teams need robust systems and trained staff to follow up on and appeal denied claims. In the absence of timely follow-up, rejected claims become lost revenue. The appeal process is complex and often requires extensive documentation and an understanding of requirements for payment.
Prior Authorization Insanity
Prior authorizations can impede patient care. Physicians have had enough. Prior authorizations burn staff hours and delay proper treatment. The average practice spends a dozen employee hours every week working on prior authorizations, nearly 50 authorizations on average per physician, per week. Automation is the ultimate choice to put an end to the madness of prior authorizations. Adopting automated solutions will not only ease the manual effort but will also enhance the efficacy of the authorization, increasing the chance of approval. RCM solutions from a trusted partner, like Virtual OfficeWare Healthcare Solutions, can quickly reduce your practice burden.
Managing Accounts Receivable
As insurance coverage and medical debt collection law changes have evolved, patient responsibility for their portion of healthcare costs has also changed. Collecting from patients can be challenging. A disrupted revenue cycle means delayed or lost payments. This impacts a practice’s ability to cover operating costs, invest in new technologies, or elevate their standard of patient care. In essence, RCM automation ensures the medical services provided translate into practice revenue without unnecessary delay and financial loss.
RCM In-house vs the Benefits of an Outsourced Solution
Why consider automated RCM solutions? Revenue cycle management is your practice’s financial heartbeat from the patient’s initial appointment through service and final payment. Missed steps means missed payments and lower ROI. From patient registration, intake, and insurance verification to effective coding and claims submission, a great RCM instantly handles payment posting, denial management, and more. Outsourcing gives practices access to experts who are current with industry changes and best practices, reducing the risks associated with billing errors and denials.
Automation Benefits Include:
- Reduced high claims denial rates
A high rate of denied claims could indicate issues with coding, billing, or submission processes. RCM solutions assess and adjust your current workflow, identifies areas needing improvement, and manages appeals.
- Improved compliance
If your practice is struggling to keep pace with regulatory changes or has experienced compliance violations, it may be time to bring in RCM professionals who are well-versed in healthcare laws and standards.
- Access to real time data and analytics
Data-driven RCM provides valuable insights into revenue trends, denial patterns, and patient collections. Without such insights, your practice can miss opportunities to optimize your revenue cycle. Professional RCM providers can offer technological solutions that allow for data integration and real-time monitoring.
- Clean compliance
Medical practices must manage their revenue cycle effectively not only to maintain their financial health, but also to provide timely and high-quality patient care. Practices with inadequate RCM expertise are more likely to lose revenue, have compliance issues, and lower patient satisfaction.
Managing outstanding patient financial balances has become increasingly challenging. RCM experts can develop patient payment plans, implement effective communication strategies, and provide patients with transparent billing information.
Whether you choose to try and manage RCM in-house, or partner with a specialized company, it’s vital to ensure that your practice’s RCM is handled by knowledgeable professionals who can stay current with industry changes. In an increasingly complex healthcare landscape, the right RCM expertise helps your practice thrive, making it possible to focus on what matters most: providing excellent patient care.
Your RCM won’t diagnose your patients, but your RCM solutions professionals can help make sure you are paid for your efforts, allowing your team the time and resources to provide patient centric care.
- Improved compliance results in reduced errors and fewer audits
Professional RCM providers are committed to compliance. They can ensure that your practice’s billing is accurate, avoiding costly penalties from incorrect coding or billing errors.
- Enhanced efficiency and reduced administrative costs
By outsourcing, practices can eliminate the need to hire, train, and retain in-house billing staff, thereby, lowering administrative costs and reducing the burden on internal teams. RCM providers often use automation to reduce manual work, further increasing practice efficiency.
- Improved insights using real-time data
With RCM services, you gain access to detailed analytics that provide insights into your practice’s financial performance, allowing for more informed decision-making.
Which RCM Solution is Right for your Practice?
If you’re considering an RCM partner, it’s important to choose one that aligns with your practice’s specific needs. Here are some factors to consider:
Industry experience. Choose a partner with a proven track record in your specialty. Technology integration is equally important, a well-researched RCM provider’s solutions can integrate seamlessly with your existing electronic health records (EHR).
Transparency and communication should be solid and clear, you must always know where your business stands financially and have easy access to your revenue cycle’s performance. Customization should not be difficult. Every practice has unique needs. When choosing an RCM solution look for a partner that can customize its services to meet your specific RCM requirements.
Grow your practice efficiently by outsourcing talent that outpaces your needs today. Contact us, together, we’ll make it happen.
