The medical practice has, and, is seeing a great many changes taking place in terms of healthcare reforms, the CMS rules & regulations with respect to reimbursements, and the ICD-10 coding system recently introduced in October 2015. These changes have affected a broad spectrum of both small, mid and large healthcare providers specifically in terms of financial revenues. Many of these organizations have suffered a setback in their Revenue Cycle Management process. The very many questions that plague the healthcare practitioners is how to determine exactly at which point in the Healthcare Cycle Management Process should they look towards outsourcing any one particular process or the entire process? Healthcare providers face many issues with respect to
- Operational costs that starts at the front office
- Documenting & Managing Data
- Trained coders and Billers
- Data Analysis – crucial aspect to improve the healthcare system
Front Office Staff: Here the questions you need ask yourself are: Is your staff qualified to deal with insurance related eligibility and verification norms? Are they able to respond in quick time to the patients who come in with types of insurances that range from Medicare and Medicaid as well as private insurance coverage? Once you submit the forms without verification, the resubmission process can be a costly affair. Will trainings solve your collection issues? Would just outsourcing the eligibility and verification process help the decline in resubmissions and increase your revenues? Could your staff be put to better use in dealing with patients rather than be hassled with patient eligibility? Here the pros and cons need to be weighed depending on your practice.
Coding and Billing: This is the most difficult of all processes given the rules and regulations and new ICD-10 coding system. One wrongly used code or modifier, or a misplaced usage of laterality of the disease could be very costly. If billers and coders are unable to translate the documentation into appropriately codes, you could be facing either long resubmission processes or even fraudulent charges! Would an appropriate mix of in-house and outsourced billers and coders make a difference to the Revenue Cycle Process? Or would just training them regularly be a benefit in the long run? Or would just outsourcing the entire billers and coders section, help increase the revenues?
Accounts Receivable: If a payment is past due date, chasing that can be very time consuming. For this segment alone many physicians outsource third-party services especially for payments up to 90 days past due, and the services can be outsourced to collections as a self-pay account in the name of the physician practice, as a third-party bad debt account.
These three main segments that affect your revenue cycles is where you need to pay attention. Checking and rechecking insurance coverage, codes and billing, and submissions is a time consuming affair, as you need to see to it regularly. Is minimizing on the staff to outsource the verification of insurance the right decision? With billers and coders, will training suffice given the new rules & regulations that are integrated into the system regularly? If outsourced, will the benefits outweigh the cons?
Thus, depending on your kind of practice- generic or specialized medical practice, outsourcing just a segment of the Revenue Cycle Management process or the entire package at all the intersections that impact revenues could be an ideal arrangement.