Increase revenue by improving billing functions

The excessive administrative work healthcare organizations are having to deal with due to reforms in the US healthcare has begun to take its toll on the revenue of healthcare organizations across all the states of the US due to several reason, like claim denials by insurers and hospitals involved in increased non-clinical activities like claim preparation and their follow-ups consuming resources, financial and man power, of care providers without adding, in the least, to the quality or delivery of their healthcare services.

HIPPA 5010, the electronic medium to transact medical data for claim submission to Medicaid and Medicare, has further compounded the problem for care providers by forcing upon them  a series of data handling activities which, if not handled with complete accuracy, lead to rejected claims.

The reform-induced administrative responsibilities have affected profitability and operating revenues of healthcare organizations in the US healthcare industry. The increased paperwork and other compliance activities have exposed hospitals to the possibility of a two-fold monetary penalty: claim denials due to inaccurate submission and penalties incurred due to noncompliance and undetected overpayment not returned to Medicaid and Medicare on time, in a post-imbursement scenario.

Apparently, the current scenario is changing the dynamics of the US healthcare industry without helping improve the quality of healthcare services. However, to blame the reforms for not helping improve healthcare quality is a futile exercise given that the reforms are not meant to ensure quality of care per se, but availability of care through insurance and reimbursement, albeit through a maze of procedural activities, which, incidentally and to a certain extent understandably, have fallen to the organizations involved in the delivery of care and, being cumbersome and outside their area of expertise, have managed to cause them considerable woes, financial and otherwise.

However, the non-healthcare responsibilities, if left to people who are better equipped to handle them, should not muddle up the core healthcare activities, leaving hospitals with more time and focus for care and helping them to ensure improved finances through proper claim submission and reduced rate of claim rejections either through an improved in-house Revenue Cycle Management (RCM) process or through an outsourcing model.

A sound RCM process helps address areas like inaccuracy in claim preparation and post-submission follow-ups, done in a methodical and scientific manner, through a close scrutiny of areas of concern to identify outdated and cumbersome processes, inadequate software applications, under-utilized workforce with inadequate knowledge of coding details and industry regulations. The RCM consulting services provides have helped healthcare providers have a robust RCM process that helps meet the current financial and administrative responsibilities helping them to reduce cost through optimized work force and leading them to improved revenues.

Many medical practices, in the US, have improved their finances due to accurate claim development,  intricate procedure coding, electronic filling and timely follow ups thanks to the outsourced billing and coding services provided by, the largest consortium of billers and coders in the US.