Some of that RCM investment focuses on improving internal practice management to facilitate effective billing collection rates at or before the point of service. For example, introducing an online payment portal and providing patient payment estimations can help reduce the number payments that go to collections.
However, true optimization of RCM requires much more than fine-tuning internal PM operations; it demands quarterly, if not monthly, RCM audits that assess the overall revenue health of your specialty practice. Moreover, practice administrators must have an in-depth understanding of RCM's quirks and complexities. This is best achieved with the assistance of an RCM services provider that can identify and address challenges that inhibit optimal cash flow.
Even with the rise in high-deductible healthcare plans, insurance companies still cover about 70 percent of healthcare costs, according to The Tennessean. As the largest potential source of revenue, proper coding at the time of service should be the No. 1 priority. This first and foremost requires a strong understanding of each of three coding systems:
Some billing outsourcing companies actually contribute to this problem by pulling codes directly from the EHR rather than performing a preliminary audit. They may take action after a claim has been denied, at which point revenues have already been delayed. Other billing outsourcing companies might check claims before charging them, but without paying close enough attention to a payer's unique coding standards.
In contrast, an ideal RCM services provider will work directly with on-site providers and administrators to create clean claims for adjudication at the time of service. Specialty practices can implement feedback from claims mechanics to continuously improve coding management processes and ultimately lower the rate of oversights and denials. The long-term result? Higher collection rates the first time around, as well as better revenue and significantly fewer frustrating RCM audits.
An ideal RCM services provider compares collections versus denial rates for clients. This helps diagnose billing practices that need to change; for example, vendors can guide the implementation of processes to verify that billed-out charges are consistently supported by proper documentation.
Often, RCM deficiencies can be traced back to issues with front-desk operations. These could be the result of simple clerical errors such as a failure to collect the right co-pay at the time of service. Other factors that can eventually lead to denied claims include failure to perform eligibility verification or obtain the necessary pre-authorization prior to the point of service.
It's also worth noting that about 30 percent of the cost of healthcare is now covered by the patient, which, according to KarenZupko & Associates makes them the #2 source of revenue for most practices. Thus, practices should do everything they can to make sure patients are aware of their payment obligations – ideally, prior to the time of service.
Whatever the source of the revenue shortfall, a strong RCM service provider will help you identify it and correct it.
AllMeds' team of billing and coding experts serve specialty practices by providing frequent feedback and reports that comprehensively assess RCM performance. We identify the factors leading to higher denials and adjustments, and make recommendations for how to ameliorate those problems – whether they originate from coding issues, improper bundling practices, or insufficient documentation to support a denial, appeals or something else.
Revenue cycle performance is arguably the most important indicator of a specialty practice's health. This has become apparent as more healthcare providers invest in new RCM resources. Case in point, the market for RCM solutions and services is projected to exceed $90 billion by 2022, up from $51 billion in 2017, according to Research and Markets.