Increasing patient cost responsibility and rising administrative responsibilities due to changing payment and care delivery models has impacted revenue cycle management (RCM) in physicians’ practices. While medical billing outsourcing can take care of business processes from patient insurance verification to claim submission and reimbursements, physicians need to know how to make smart decisions on RCM workflow. Here are some tips for efficiency in revenue-related processes:
- Choose the right practice management system (PMS): Medical billing service providers can work on any type of PMS to improve practice collections. However, having the right software is crucial to harness the efficiencies that electronic transactions and workflows can provide.
- Improve patient collections processes: With more and more people opting for high-deductible healthcare plans, physicians should revamp their billing and payment collections practices. They need to train their staff to implement and manage self-pay collections in a proactive manner, while being sensitive to patients’ out-of-pocket expenses. Physicians should have open discussions with patients on various treatment options as well as their payment responsibilities.
- Expand focus on denials management and denials prevention: Recent reforms such as ICD-10 code updates, value-based reimbursement models, and reduced payment rates make denials management really important. The American Medical Association’s (AMA) reported that while almost five percent of claims were denied by Medicare in 2013, for major private payers, claim denial rates ranged from 0.54 percent to 2.64 percent. Therefore, the need of the hour is a proper strategy to analyze why payers deny claims and steps to correct and prevent denials.
- Use RCM analytics tools: Adoption of data analytics is necessary to drive quality improvement. Advanced analytics will provide increased data validity, access, and utility for information related to charges, payments, days in A/R, and collection. In fact, medical billing companies use advanced analytics to prepare customized financial reports for practices.
- Implement a clinical document improvement (CDI) program: CDI can directly impact RCM and promote long-term financial stability. Medical coders help physicians ensure accurate, complete and compliant clinical documentation. CDI specialists need to work in collaboration with physicians and coders to maximize practice reimbursement.
An efficient revenue management system is crucial for a practice’s financial health and sustainability. As physicians provide patient-centric care, medical billing and coding outsourcing is a practical solution to their revenue cycle management issues. A trusted partner can help healthcare providers operate smoothly, maximize reimbursement, and improve the patient experience.
