Should You Outsource Your Physician Billing
& Your Revenue Cycle Management?

Revenue Cycle Management (RCM) refers to identifying, collecting, and managing the revenue from payers based on the services provided. A successful RCM process is essential for a healthcare practice to maintain financial viability and provide quality care for its patients.

COVID-19 has affected medical practices, especially when it comes to finances. The move toward value-based reimbursement and improving comprehensive care for patients pressures practitioners to give more attention to their RCM procedures.

If your billing practices are deficient, your practice will see a negative impact on the bottom line. When this occurs, the ability to provide quality care can diminish. Making changes to develop better operational measures can have a positive financial impact.

COVID-19 has affected medical practices, especially when it comes to finances.


What is a Challenge to Revenue Cycle Management?

The revenue cycle starts when a patient (or their caretaker) makes an appointment and ends with collecting the payment. The process sounds easy enough. Simple though it sounds, there are many steps in the process that can cause a breakdown.

This breakdown can happen due to

  • human errors are there are coding complexities
  • bad communication
  • duplication of data
  • incomplete information
  • misspellings

These breakdowns often have a negative impact on the Revenue Cycle Management.

Healthcare regulations and reimbursement models can make receiving timely reimbursement challenging, as they are many changes. As the regulations increase, the workload on a staff’s time increases. We know the workload on medical personnel is often already stretched to the max. Healthcare providers often work with limited available resources. For providers to achieve RCM success, it usually requires focusing on improving efficiency with administrative tasks.

Factors That Can Affect RCM

Often as a provider, you may feel helpless. You have very little control over the process, from the claim review and denial process. Long waits for billing and claims to be processed for provider payments can result from claims denied due to insurance eligibility issues and the increasing efforts to combat healthcare fraud and abuse.

Healthcare fraud investigations are costly. Whether part of a hospital, physician group, or private practice, fraud can drain both time and financial resources. Fraud costs the healthcare industry tens of billions every year. Healthcare providers also suffer damages to their reputations as a consequence of fraud.

What causes healthcare fraud? One significant source is inaccurate medical coding. Coding errors can arise for various reasons, but poor process management can be a direct reason for mistakes in coding services rendered.

However, there are some internal factors that the provider may have some control over. Productivity, patient volume, and collecting fees for service are areas that providers can improve upon their RCM. Issues that can disrupt the RCM process include:

Collecting Patient Payments

The patient’s responsibility for healthcare costs is continuing to expand. If patient payments are collected during or before their service, then the risk of non-payment is avoided altogether. The reality is many patients are struggling to afford high deductibles and unawareness of their financial responsibility.

Patient pre-registration is essential to gaining the most accurate information about medical history and insurance information upfront to reduce claim denials. Patient pre-registration can permit front-loading the payment process by gathering data about insurance coverage, additional insurance, their maximum allowable visits, and determining the patient’s financial responsibility.

Cracks in the Administrative Processes

The front and the back end of the office often have different priorities.

When information isn’t effectively communicated, the result is claim denials. Improving communication during patient intake about coverage eligibility can assist with payer coordination, claims reimbursement and may improve payment collections.

Focus on front-end administrative tasks to readily handle claims and assist uninsured patients in understanding their coverage options with insurance exchanges. A validation process for patient insurance information is often overlooked with subsequent visits and can result in eligibility denials.

Eligibility Issues

Developing and improving the procedure to communicate with health care insurance companies is very important. Neglecting to manage the claims process after submission can result in pending, rejected, or denied claims or ones that were never received. Tracking claims to determine where problems originate, such as determining if there are issues with specific procedures or codes, can help increase awareness and reduce recurrences.

Lack of Digital Workflow

Poor quality data and future revenue cycle complications can occur without the ability to streamline the digital workflow. Developing a robust supporting healthcare IT infrastructure can assist with Revenue Cycle Management and the ability to process crucial reports. Implementing an electronic workflow can also help to seamlessly coordinate front and back communication and eliminate lost paper documentation.

Invest in an Expert Partner

Outsourcing medical billing can save medical practices money. In addition to the money you save on in-house start-up costs, you can also save money on administrative salaries and benefits, software, supplies, and equipment.

Medical billing providers are experts in the insurance field. When hiring independent medical billers to work in-house, you risk low claim success rates. This can be seriously threatening to your revenue and your business. Reports show that medical billing claims are incorrect 10% of the time, and it can impact revenue by 11%. If you hire an expert medical billing provider specializing in avoiding these issues, you can prevent these risks, and rest assured that your finances will be handled professionally. It’s the full-time job of the medical biller to make sure your practice is following legal insurance protocols. Plus, outsourced medical billing providers have the means to focus all their time on mending any rejected claims quickly, so you get your money.

The AMA report illustrates one of the critical areas previously addressed in a Thomson Reuters study that estimated the U.S. healthcare system wastes between $600 billion and $850 billion annually due to errors and inefficiency.

Who ends up paying for these mistakes? Patients and physicians end up covering the cost of the error-prone insurance companies

Physicians were not paid on almost 23% of the claims they submitted to commercial health insurers.

Benefits of Outsourcing Your Revenue Cycle Management System

Outsourcing your revenue cycle to a dedicated team of experts saves you money and time associated with in-house billing — an experienced outsourced RCM team also guarantees maximum claim reimbursements.

Managing the Revenue Cycle Management Process with Medical Management Services.

Focusing on examining and improving an organization’s Revenue Cycle Management (RCM) core operations systems can allow the provider to manage the RCM process rather than allowing the claims to impact the provider’s financial viability. A focus on early detection of issues with pre-registration may help identify eligibility issues to assist in preventing initial claim rejection, while partnering with an experienced Revenue Cycle Management service provider may help ensure that timely reimbursement is received.

For assistance managing and improving your Revenue Cycle, contact Mark Manning of Medical Management Services at 706.315.4660.