If you’re a veteran in the healthcare field, I’m sure healthcare revenue cycle management comes second nature to you… or you at least know what it is. But for anyone new here, it can seem like a tangled web of terms, regulations and uncertainty.
Providing healthcare no longer just stays between a doctor and the patient, it now involves many different parties.
Take government programs and insurance companies for example. These entities allow providers to extend medical treatment to those who may not be able to afford it. With national health spending estimated to reach $6.8 trillion by 2030, being able to receive faster reimbursement is essential to keeping practices’ finances afloat.
Managing your revenue cycle alone can be overwhelming. Having the stress of wearing many hats within a company naturally takes you away from providing your best patient care. Handling the balance of more procedures, providers and cashflow relies on a good game plan.
Revenue cycle management, or RCM, is a term used to describe how healthcare organizations track their patients from registration to billing. RCM software helps businesses merge their clinical and administrative duties by providing a secure space to store protected health information. Here’s our ultimate guide to outsourcing revenue cycle management.
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Advantages of Revenue Cycle Management
There are plenty of advantages when it comes to making sure you have a solid revenue cycle management game plan. After all, it’s better to be safe than sorry!
Advantage 1: Automation
One of the main perks is the ability to automate your administrative and billing duties. Your front desk will thank you, trust me. Handling hours of tedious work with the click of a button free up more time for patient care. Functions such as patient reminders, calculating existing patient balances, handling claim denials, and more will be at your disposal.
By reducing the amount of work for your front desk or administration team, your company will be able to lessen the amount of administrative overhead. Or in other words, you can save more money.
Advantage 2: Clear Communication
Not only that but the amount of miscommunication will decrease as well. Having a smaller group of people handling the streamlining of information means fewer people making mistakes and causing errors in the cycle. The fewer errors throughout the cycle mean quicker reimbursement for services given.
For example, let’s take a look at claim rejections. What are some of the main reasons for a claim rejection? Missing patient information, timely filing and incorrect data entry are a few I can name off the top of my head. Being able to slow down and allow yourself the time to double-check your information will save you from unnecessary delays and lost revenue.
By installing these automated functions, you can help your company run smoothly. With roughly a 20% increase in claim denials in the last 5 years, it’s no wonder RCM software is in high demand.
Outsourcing Revenue Cycle Management
If you’re feeling overwhelmed, that’s okay! I have good news for you.
While revenue cycle management can be a bit complex, you don’t have to handle it all by yourself. RCM companies understand that investing in this technology means that you’ll gather more data and institute more safeguards to your process.
This can be even more time-consuming and no matter how helpful it is, this can provide more stress for your team. That’s why the option of outsourcing your administrative functions through these companies is available.
Outsourced RCM completes the same RCM tasks you would usually handle with your own team but delegates some or all of it to a third party.
So what kind of services are usually available when you outsource this work?
It really comes down to what you need and can be pretty customizable depending on the company you use.
Here are a few of the more common services when outsourcing for RCM…
Charge entry
Claim submission
Claim appeals
Coding
HIPAA compliance
Online patient payments
Patient Collections
Patient Inquiries
Patient Statements
Payment posting
Data Reporting
The more services you have access to the higher your RCM costs will be. By determining your priorities within the company and the size of the organization, you can decide on what services are necessary.
The Benefits of Outsourcing RCM
Benefit 1: Improved Patient Care
Managing your business from both an administrative aspect and a patient aspect is a time-consuming job. Even just addressing administrative tasks can be stressful.
But we know that as a medical professional your top priority is your patients. Stop spending hours focusing on paperwork and fixing claim denials by outsourcing your RCM services.
When you outsource your revenue cycle services, it frees your time to better focus on your patients and ensure thorough documentation.
Rushed exams can cause medical coding errors, or worse, and may leave a patient feeling unheard or like they don’t matter. Removing the majority of the administrative workload from the direct care providers allows for better accuracy in care and higher patient satisfaction.
Benefit 2: Timely Reimbursements
As we mentioned before, one of the most common reasons for delays in receiving reimbursement is due to claim denials. ICD codes and CPT codes must be correct before sending them to a payer.
If not, the claims can face a delay that could last weeks or even months. Oftentimes you won't get a notification that there is a claim denial until days later.
To avoid this and to avoid delays in processed claims, using code check software and sending claims to clearing houses is a helpful RCM service.
Benefit 3: Reduces Costs
If you choose to handle all of your RCM needs in-house, you will need to hire the appropriate staff.
Coding and billing are both tedious and full-time jobs and while hiring professionals can make the process smoother, you must consider the added expenses with new hires.
When you hire within your company you will need to consider additional expenses such as salary, benefits, training, and more.
If you outsource your RCM needs, you only need to pay a flat monthly rate while receiving professional services. There’s also the option of upgrading or downgrading your services at any time if you need to adjust your spending. Much better than having to let someone go.
Benefit 4: Better Workflow
One of the most pain-relieving aspects of outsourcing your revenue cycle management relates to how it forces your organization to operate better. To be more specific, outsourcing to the right clearinghouse (like ours) provides you with the ability to run a series of must-have checks on the claims you submit BEFORE they reach the payer.
Yes, I’m referring to claim scrubbing.
Although payers should cooperate with you in order to compensate you, sometimes it doesn’t feel that way. But, a true clearinghouse partner exists as a middleman between you and the payer.
Meanwhile, it adds a few essential steps to your claim submission process that cuts down on your denials in the name of increasing your revenue.
Benefit 5: Decreases Stress
This goes without saying but operating a clinic, hospital, or any other healthcare organization comes with a lot of work.
Managing your employees, taking care of customers, and day-to-day operations are just a few of the things to worry about.
With all of this, there’s one of the most important aspects of the business that needs full attention regardless - finances. Making sure you have someone to be able to keep track of your numbers and revenue can help you avoid costly coding or billing mistakes.
By not putting all of the burdens on your team, you not only will avoid mistakes but have a happier and more productive work environment. Research from the University of Warwick suggests that happy employees are around 12% more productive.
Conclusion
Revenue cycle management is crucial when considering the best way to run any business. As we went over in this blog, healthcare is no exception.
If anything, this changing and evolving field needs some kind of structure to stay financially stable. There are plenty of tools in the RCM tool belt that you can use to increase revenue and cut overhead costs, and you can customize your belt however you’d like!
If you choose to continue with outsourcing your RCM, the services themselves aren’t the only things to consider while shopping. When you choose a vendor you should also consider pricing models, service guarantees, user integration, data privacy, and call center availability.
This isn’t an extensive list of everything you will need to look into, but just some of the basics. Choosing the right RCM provider can mean the difference between a profitable establishment and a struggling business.
