In our previous blogs, MBC has highlighted ways in which you can focus on the health of your patient and yet manage to deliver error free claims and reduce your medical billing costs just by outsourcing your billing revenue cycle. The new rules and regulations introduced by the Accountability Care Act (ACA) have led to a host of administrative and operation complexities in the medical practice. This inevitably leads to higher investment in not just trained staff that keeps updated about the regular updates introduced by the CMS but constant upgrades for software and hardware. This leads to misdirection of attention to such overheads rather than focusing on Patient Care- your passion. Further, for smaller practices, the introduction of Value-based care is impacting the revenues of healthcare providers who need to ensure they receive every dollar earned while giving quality patient care.
Here we provide a 7 step approach that can help you keep your focus centered, i.e. patient healthcare, and yet align your practice towards increasing your revenues while minimizing certain expenses and the risk of reimbursement loss.
- Vigilant Patient Verification & Eligibility: This is very essential as even a tiny spelling mistake will have the payer rejecting or denying the claim. Ensure that all patient details are checked as per payer forms and their insurance details upfront. Moreover, if the patient is not covered by the payer, could mean loss of revenue for your practice. This is time consuming and can take a lot of effort. Either providing a checklist to your staff or outsourcing the verification and eligibility could help you save a lot of not just time but even dollars.
- Maintenance of Electronic Health Records (EHR): Healthcare authorities are now insisting on meaningful use of EHR, a tool which helps to effectively manage patient medical records for security as well as helping to devise healthcare plans. This also aids in minimizing documentation issues and errors. The need to invest could prove costly both in terms of operation as well as administrative (training staff and software upgrades). But when outsourced that part is taken care of and hence streamlined and also helping meet government compliance.
- Stringent Billing & coding: Even a small coding error can mean diminished returns as the claim will be either denied or rejected. Moreover, CMSs constant changes in the introduction of new codes and modifiers, requires a knowledgeable staff and efficient systems. Moving towards an integrated end-to-end system that integrates both the front and back office data flow, provides seamless workflows, and streamlines the coding and billing process integrated with the practice management process will ensure a healthy cash inflow.
- Enhanced Practice Management: For any healthcare provider, the need to put into place a practice management process is very essential. Practice management system not only help to furnish basic reports like days in A/R aging by payer or the productivity of individual providers, but can also help managers why certain kinds of claims have been denied, which health plans present consistent problems in certain areas, or why claims get held up when they’re being prepared and validated. By streamlining this process, and integrating it with the and the RCM process, ensures a much more efficient way to ensure that your revenues continue to flow and rectify discrepancies when detected.
- Effective Revenue Cycle management (RCM): This is the most critical of all processes to ensure that revenue is not lost. It involves claims processing, payment and revenue generation, and now entails the use of technology to keep track of the claims process at every check point. It is a known fact, as per the Medical Group Management Association (MGMA), that nearly 50-65 percent of denials go unclaimed. This means that not only are you missing out on revenue, but also on the chance to spot denial trends and prevent future occurrences. Resubmission of claims means loss of dollars in your cash flow as it costs an average of $25 per claim for the resubmission process. Imagine, just 50 denied claims means a loss of $1,250 in administrative costs alone. According to a report from Micro Market Monitor, the revenue cycle management market is currently valued at $20.5 billion and is estimated to reach $40.4 billion by 2021, at a developing CAGR of 12.0 percent from 2016 to 2021. Errors in revenue cycle management can result anywhere between a 3 percent to 5 percent loss of revenues in hospitals/clinics. It is thus advisable to outsource the RCM to concentrate on patient health.
- Improved Automation of Accounts/Receivable: This is the key to having an efficient and effective healthcare practice. It has been recorded that nearly 26 percent of self-employed doctors and 35 percent of those employed in the healthcare industry spend 10+ hours per week on paperwork and administration! Moreover, automation can help provide an error free claims process- as once data of the patient has been correctly entered, then processing later will be hassle free as automatic updates to your system will be available with respect to not just verification but also insurance eligibility. Moreover, automation in coding and billing can help increase the efficiency and decrease the chances of claim denial and thus make effective the Accounts Receivable (A/R) process. Practices whose receivables are past due over 90 days means a loss of revenue and when this process is automated the issues can be addressed to shorten the payment time frame and prevent similar problems in the future.
- Scrupulous Compliance: Being compliant in today’s medical practice can save you dollars. The number of reports that need to be submitted online and meeting the auditing compliance process, is very essential that your practice does not get hauled up for waste, abuse or fraud and thus avoid costly and inconvenient potential legal pitfalls.
Healthcare providers who follow the above 7 step approach, and strategize on either outsourcing the entire medical billing and coding process or just their Revenue Cycle Management (RCM) or Electronic Health Management (EHR) process will definitely see revenues increasing due to a more efficient process that can be integrated with in-house systems and processes.