The challenge of shifting to value-based performance has got many physicians and hospitals thinking about outsourcing their Revenue Cycle Management. Black Book, the industry watchdog has mentioned that many hospitals have outsourced either part or the whole RCM to outside companies, as dealing with the administrative part of the RCM takes up a lot of their effort and focus is then no longer on patients.
Let’s understand first what issues most staff at the physician’s clinic or hospital face which affects the RCM and how outsourcing the below will help resolve staff issues
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Changing health care reforms:
Changing healthcare reforms requires the staff to know and keep updated about not just the coding and billing aspects but also vendor and provider changing demands. Healthcare reforms also leads to the way providers and vendors will interact with the claims and bills which can lead to high denials and thus backlog of paperwork leading to lower productivity among the staff
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Antiquated RCM systems:
Outdated systems cannot be made to change overnight. Hardware and software need updating with the changing healthcare requirements and this requires capital investments that most clinics and hospitals find it difficult to afford especially when struggling to increase reimbursements via their practice
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Outdated Knowledge:
The changing healthcare reform brings in a lot of new knowledge and a change in process is often the outcome. Right from patient interaction while filling forms for submission and refilling which requires a lot of knowledge and expertise which calls for regular training for the staff? Can one afford that on a regular basis? Also handling new technology put a strain on staff and causes low productivity in the long run.
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Excessive administrative overheads:
When you have your own staff deal with the form filling and postage, a lot of stationery and postage and filing of papers is involved. Moreover with the new system pushing in for filing of claims, the overhead costs will increase, leading to a further drain on the stressed resources both human as well as financial
All the above can lead to lower productivity among your staff which causes loss of focus on your main aim, i.e patient satisfaction, which is now part of the Value based performance rating upon which reimbursements will be further disbursed. One, but not necessarily the only one way to solve the above issue is to outsource or co-source the RCM cycle which ensures the following advantages to your staff:
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Focus and emphasis is then directed more on core business, given experts handle the revenue cycle
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Improved staff workflow and effective communication channels
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Decrease in manual follow-ups especially in A/R days
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Automation of time consuming tasks frees up the staff time and thereby also dependency on human resources which can be put to better use such as patient care
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Increased productivity and lowered stress among staff
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Patient care process is much more efficiently handled increasing your value based performance
Once staff issues are resolved, and your RCM cycle is efficiently working and integrated with the in-house staff, it is only a matter of time before revenue shows an increase, given that billing is not the core business but a bigger part of the medical practice!
Published By - Medical Billers and Coders
Published Date - Sep-30-2015
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