You usually aren’t required to pay for the service in full at the time of visit when you visit a doctor. In certain cases, you may be required to pay a copay; however, the provider will need to obtain payment from the insurance company in full. In certain cases, a charge may arrive weeks or even months after a service is provided. Efficient billing and payment processing is guaranteed by a strong revenue cycle management procedure. It is a challenging task for medical clinics to implement revenue cycle management (RCM).
Learn more about some of the typical issues with revenue cycle management that medical practices deal with, as well as how your office can resolve them, by reading on.
Here are some of the challenges related to revenue cycle management:
1. Collecting payments in a timely manner
Receiving compensation soon after services are rendered is one of the largest problems providers encounter. Indeed, almost fifty percent of executives in the healthcare industry recently concurred that the largest obstacle facing their operations is being paid. Patients are expected to pay for more out-of-pocket expenses in the age of ever-rising deductibles, and that can be difficult at times. Accordingly, a 2017 study discovered that 68% of hospital patients with invoices under $500 failed to pay the entire amount owed. It’s far more difficult to maintain seamless operations when money doesn’t flow into your practice fast.
2. Spending too much time on revenue cycle management
The goal of medical practices is to enable individuals to live longer, healthier lives. In order to carry out their objective, they are also involved in revenue cycle optimization. Practices frequently lack the equipment and resources required to handle RCM efficiently. As a result, team members end up devoting far too much time to RCM rather of allocating their energies to other crucial operational areas.
3. Dealing with too many coding errors
Practices lose time and money as a result of coding errors, which include upcoding, unbundling codes, using modifiers inappropriately, and using unlisted codes without proper documentation. Providers frequently have to deal with a high volume of claim denials when they continue to use an antiquated method of revenue cycle management. Expenses mount up when those rejections are managed manually.
4. Lacking deep insight into the revenue cycle
Many healthcare professionals struggle to gather the information they require to decide how to proceed and make sure their RCM strategy is the appropriate one. Complete revenue cycle visibility and KPI measurement, such as cost to collect, claim rejection rate, and percentage of cash collection from net revenue, are achievable with the appropriate technologies in place. Practices may keep improving these KPIs over time, which will strengthen the RCM engine over time.
5. Advancing interoperability between clinical and financial systems
In the contemporary healthcare setting, data interoperability is the cornerstone of success. A single patient can interact with over six health IT systems during a specialty healthcare interaction, including electronic medical records, digital drug dispensing platforms, specialized imaging and radiation therapy applications, and clinical laboratory and pharmacy solutions.
These platforms all record a staggering amount of clinical activity. Accurate documentation of the reimbursable services rendered and a thorough, current picture of the patient’s clinical status depend on systems interoperability.
It is imperative for specialty providers to provide a data infrastructure that facilitates the seamless coordination of clinical activity collection, gives doctors a comprehensive understanding of the patient’s condition, and guarantees the right integration of relevant financial data into business office operations. This smooth approach to interoperability can support some of the essential roles specific to specialty care, like basing future appointments for patients on the completion of regimen-driven clinical milestones or taking prior authorization requirements into account when creating a treatment plan.
6. Ensuring complete and accurate charge capture
Charge capture, coding, and billing accuracy are best achieved when clinical and financial environments are interoperable. Practices need automation to make sure that medical claims have enough information about a patient’s diagnoses and treatments to be eligible for the right compensation because numerous systems create the information needed to handle extremely complicated medical cases.
What to Look For in a Revenue Cycle Management Partner
An increasing number of medical practices are investing in revenue cycle management solutions that are specifically designed to address these issues.
Proven software
Purchasing strong medical billing software makes it much simpler to handle insurance eligibility checks, process claims, and automatically notify patients when payments are due—all without requiring a lot of human labor.
RCM services
It could be better to outsource these duties to a third party rather than handle the revenue cycle internally. With the proper partner, you may get direct access to a team of billing experts and boost your clean claims percentage to up to 99 percent.
A track record of success
Examine customer reviews of each supplier as you start to reduce your options. Finding the industry’s established leaders and those who are trailing should be simple.