Toll Free 888-357-3226

How to Alter Your RCM Process to Adapt to ACO Requirements

September 12, 2013

An ACO (Accountable Care Organization) is formed by a group of healthcare providers in coordination to provide treatment and care for a certain group of patients. The main aim of an ACO is to maximize quality and simultaneously reduce costs for Medicare patients, in keeping with the numerous medical reforms that are set to sweep across America. ACOs aim to establish a smooth link between the various providers of healthcare services, enabling the treatment to be efficiently handled. In the past, many Medicare patients have suffered because of hampered communication between the multiple healthcare providers, in turn increasing costs. Many estimates suggest that the shift to ACOs will go on to save around $960 million over a period of three years. ACOs will also give patients much higher control over the decisions that need to be made for their treatments. They will act as partners to the doctors and can access the doctor’s records related to quality care standards. They can also pick the doctors of their choice from the list of healthcare providers.

A Look into Revenue Cycle Management

Revenue Cycle Management, known in short as RCM, can be defined as the complete billing process that is undertaken in the healthcare sector for the payment of healthcare providers. It is most used when the services of a third party billing company are employed. The revenue cycle consists of the following steps:

  • Entering and editing information in order to create an appropriate billing claim.
  • Coding. This process can also be completed by a physician.
  • Checking the accuracy of information. Inaccurate information can lead to non-payment from the insurance company’s side.
  • Medical billing software is used for filing the claims.

Most hospitals and other medical clinics across America use the RCM process. However, experts suggest that RCM could soon die out, thanks to the multiple payment reforms that are on the horizon for the healthcare sector. With ACOs becoming the new trend, it is essential for companies to start looking for proper RCM partners, to capture the critical data that is vital for the transition into these newer business models.

The Role of MBC and the need of a billing partner

The multiple insurance products that are available in the healthcare industry nowadays make it difficult for clinics and hospitals to accurately keep track of information.

Browse All : Medical Billing Services

Many clinics are outsourcing their business needs to third party billing companies, who have trained employees to take care of the billing business. Some of the advantages that third party medical billing partners offer are:

  • Greater effectiveness and efficiency in terms of billing: Third party billing companies specialize in the billing and coding process, and therefore can get work done faster and more accurately
  • Greater Cash Flow: Submitting correct information at the correct times can make a great difference to the cash flow of your clinic, and this is something third party companies are experts at doing
  • Simplifying the Collections Process: Third party billing companies make light work of difficult processes like self-pay portions of patients which are a part of your bills

Medical Billers and Coders are known for their expertise and also the latest technology which is required to tackle the problems of the coding and billing processes in modern day healthcare in order to ensure fair payments for both physicians and various medical practices. In an environment which is shifting towards ACO and value-based care, the billing process is also going to face complex changes. Medical Billers and Coders have the experience needed to adapt to the requirements of ACO.


Category : Revenue Cycle Management