April 04, 2012
If the insurance-driven nature of US healthcare leaving care providers to sort out administrative issues to ensure successful claim submission and reimbursement is one side of the problems US healthcare providers face, the other side is patients unwilling or unable to pay the share of the medical bill that’s not covered by their insurance, leading to unrealized patient collections for care providers affecting their revenue and crippling their profitability. However, unlike the unpaid-insurance-claim problem where the larger part of the blame can be laid on cumbersome healthcare policies and procedure, with unpaid patient collections healthcare policies are out of the equation leaving healthcare providers and their patients to share the blame.
While patients’ part of the blame is simple – inability or reluctance to pay- the care provider can be indicted on several fronts, like lack of prior verification of the patient’s insurance coverage; absence of a clear written policy about the financial responsibility of the patient; non-identification of time lost between delivery of service and date of charge entry; absence of data on reasons of payment denials by patients leading to lost opportunity to train employees on how to avoid mistakes made in the past; lack of cross-training of billing staff so that, say, a person being on leave doesn’t interrupt the process with another person stepping in to continue it; use of obsolete billing software applications, etc.
After being denied payments on time by patients, when care providers try realizing them by sending out patient collection letters, they meet with disappointments with the letters not eliciting any response from the patients and the letters being aggressive in tone, additionally, exposing care providers to the risk of disrupting their relationship with patients which in a competitive environment with other care providers always on the prowl for poaching patients can have the potential to lead to loss of clients.
A cursory look at these problems will tell you that none of them is part of core healthcare, but issues that – however important for a care center to operate profitably – should be left to people best equipped to handle them.
A strong Revenue Management System (RCM) will address all the areas of concern, enabling the care provider to build and maintain a data gathering and management system which will net the entire set of medical data starting from accurate verification of insurance coverage through such medical details as are required to prepare and submit claims, which although not a part of patient collection is inseparably intertwined with the overall financial process of an organization and require medical details that are identical to patient collection. Additionally, a good RCM process will identify and address training needs that, in the case of patient collection, will ensure the in-house personnel are not just familiar with procedural details of their own line of work but are also proficient in cross-functional responsibilities ensuring, as a result, the continuity of a process in the absence of a staff.
Medicalbillersandcoders.com has helped set up and strengthen the RCM process of many a healthcare provider through its RCM consulting services that perform a thorough study of your environment and help you have an RCM process which runs parallel with your treatment procedure without interrupting it but absorbing and maintaining medical details quietly and efficiently and helping your organization to respond to any administrative responsibilities, either reimbursement or collection.
Medicalbillersandcoders.com, the largest consortium of billers and coders in the US, has a network which spans across all the states of the US bringing healthcare providers a unique platform which combines the range of a national network and immediacy of a local operator. The billing and coding outsourcing services offered by Medicalbillersnadcoders.com combine this network with a team of specialists with years of experience in dealing with intricacies of billing and coding to ensure an end-to-end support for your patient collection responsibilities, leaving you to do what you do best – healthcare.
Revenue Cycle Management