Revenue Cycle Management (RCM) includes all activities directed toward receiving accurate patient and insurance reimbursements for delivered services. As most practices struggle with reduced practice collections and increasing expenses, we shared RCM tips that will help you to improve your practice collections.
Reducing Claim Denials
Practices are struggling with ever increasing percentage of denied claims. Denied claims are one of the most predictable problems affecting the healthcare organization’s cash flow. Various sources estimate that the average denial rate for healthcare industry ranges from 10 percent to 25 percent of all claims submitted. However, as per the report of the Medical Group Management Association (MGMA) the best healthcare organization should have a denial rate of only 4 percent.
You must form team of billing experts for denial management and resolution. Just submitting claim is not sufficient, you have to track each and every claim, read every line item of EOB/ERA and understand the denial code. You must follow up on all denied claims and investigate the missing values and determine what needs to be submitted. Review every denied claim, talk to insurance rep and ask for resolution. Based of conversation with insurance rep and inputs from billing experts, correct the claim, provide additional information required, recheck documentation and resubmit the claim without further delay. Don’t resubmit the claims without proper analysis, otherwise resubmitted claims will again get denied increasing days of your payment cycle.
Reducing Write-offs
Some write-offs seem necessary, and others do not. Your billing team should have sufficient knowledge on how to review each account. Mostly the practices do not emphasize lower amount of payments, but some patients make payments in installments. If those small payments are not managed properly, then it eventually affects the balance sheet of your organization. Therefore, you must remember that a brief review of each overdue of patient account can lead to the reimbursement of your organization.
You must identify and create a strategy to reduce unnecessary write-offs. To define a successful strategy, you must review the past data and accordingly determine a benchmark of the average write-off rate. This will help you to set a limit for the annual write-offs that you can control. You must determine, which write-offs would require managerial approval. This will help you to accelerate smaller or less contentious accounts. Planned monitoring and tracking of write-offs help you identify issues within your reimbursement policies and procedures. Tracking helps you identify the problem associated with the higher spikes.
Reducing Bad Debt
Rising bad debt is becoming the most common medical AR problem, whereas patient responsibility contributes to more than one-quarter of the healthcare industry’s revenue. Earlier patient’s responsibility was only at the time of service, but now it is no longer enough to discuss patient responsibility only at the time of service. In order to improve patient collections, it is critical to collect payment during the entire revenue cycle.
To keep away from the bad debt, your healthcare organization must gather all the necessary billing, insurance information, and calculate the expected out-of-pocket costs before providing the service to the patient. So, by verifying that coverage, the patient would understand the scenario and agrees to their responsibility. Providing this kind of comprehensive billing experience will dramatically improve the likelihood of payment, and helps maintain a good relationship with your patient and ensures that they have positive billing experience.
Collect More
Healthcare professionals pledge to help patients, not to collect money from them. You might be good at providing better patient experience but may not be good at collecting money from patients. But getting paid for services provided is also crucial for maintaining a successful practice, and continuing to provide care. Therefore, to make account receivable a priority, your healthcare organization must foster a good culture of collection.
Your front desk staff must be well versed with all billing terminologies. They must be well equipped with information containing patient’s insurance coverage report. They must be able to answer all billing related questions asked by patients. Insurance coverage report will help you to find out exact patient responsibility, so your front desk staff can collect co-payments or deductible amounts at time of visit only. To promote a quality culture of collection, you need to build the right team and provide them with the right training and tools to manage the successful collection.
The revenue cycle management constitutes complex set of tasks requiring unique medical speciality wise billing expertise. If your organization is surrounded by the problems that are associated with reduced practice collections and increasing expenses then you must reconsider the option of outsourcing your medical billing services. Medisys Data Solutions is such an outsourced medical billing company providing RCM services as per medical speciality. Once you have given us responsibility of medical billing, you can forget about all technicality of billing and can just focus on patient care. To know more about our medical billing and coding services, contact us at info@medisysdata.com/ 302-261-9187
