While the US healthcare system is in the process of making its shift from fee-for-service care to value-based care, it is unfortunately still wasting trillions of dollars on processing medical bills and managing costs and revenue – and will continue to suffer losses till the shift is complete. The flaws in the system are particularly alarming when it comes to interactions between payers, providers, and patients.
According to CAQH 2016, revenue cycle inadequacies due to manual billing systems can eat up to 15 cents of every dollar made. Healthcare practices lose between 5-12% because of denials, poor negotiations, and underpayments. Fortunately, improved awareness means healthcare providers are beginning to understand the gains associated with incorporating advanced Revenue Cycle Management Solution in practices. They are identifying the value that RCM systems offer in order to innovate and streamline revenues.
Why You Need Specialized RCM Solutions
Revenue Cycle Management governs all the financial operations required to get paid for the services performed. RCM is currently an essential need for healthcare practices due to a number of discrepancies:
- Cost to collections needs to be much lower.
- Better technology is required to prevent operational issues.
- High-dollar claims need specialized expertise.
- Underpayments are causing major revenue loss.
- Better payment negotiation with payers is needed.
- New practices need a quicker ROI.
Benefits of Specialized Healthcare RCM Solutions
Specialized Billing when done right can enhance internal and external communication by bridging the gap between the business and the clinical sides. It subsequently allows practices to tie all the departments together for optimal collaboration between all stakeholders.
High-quality RCM solutions – when tied directly with the EHR, practice management and patient portals – significantly reduce communication breakdowns, operational bottlenecks, and service degradation. These directly decrease duplication of effort, human error, cost of collection and account receivables.
For More Information: 9 Key Ways to Improve Revenue Cycle Management
Some advanced level RCM solutions come with business Intelligence and Adhoc reporting tools, turning data into decisions for quick and informed decision-making.
Not only do RCM solutions manage finances well, but they connect administrative and clinical information – including a patient’s demographics, clinical and insurance information.
High-quality RCM solutions include self-service components like patient portals to provide up-to-date account information. Patients can gain direct information about claim amounts, balances due and insurance information.
Better Claim Handling
By outsourcing billing to an expert and automated system, providers save money by reducing denied claims that usually result from manual processing. It is estimated that not only does the average denial rate drop by up to 4-7%, but providers are also likely to derive benefit from increased reimbursement rate, ultimately speeding up the revenue cycle of practice.
Reduced Billing Errors
A major gain that comes from experienced specialists is the knowledge and expertise that comes from advanced level up-to-date knowledge. With trained staff and rule-based technology, a specialized RCM system is unlikely to make common billing errors that occur in manual handling – incomplete/incorrect patient information, incorrect amounts, wrong CPT codes, incorrect modifier, etc. Not only does this make for quicker payment but reduces the time clinicians spend in constant staff training.
Enhanced Cash Flow
When independent medical practices carry out billing processes themselves, it is often the case that one person is assigned to each aspect. This means that human errors, unavailability, and missed deadlines could halt or impact the entire cash flow. With a specialized billing service, an expert team handles the processes, making sure the handling is continuous, smooth and on schedule at all times. It is also estimated that the average number of days with cash on hand increases by up to 22 days.
In-house billing may not always be updated with changes in regulations, causing compliance issues, claim rejections and subsequent insurance audits. An expert RCM partner, on the other hand, will ensure to maintain full compliance across clinical, administrative, and billing processes while staying up to date with regulation changes. This saves provider/management time and effort while reducing the need to worry about payer policies, industry regulations, and compliance updates.
Improved Analysis and Planning
With financial processes streamlined, it becomes easier for medical practices to monitor progress by analyzing billing data and creating performance evaluation reports. Reputed RCM systems provide data mining services through analytics tools to monitor and analyze revenue trends. It is ideal for healthcare providers to use data insights to make informed business decisions, and to subsequently covert findings into process enhancements.
Steady Pace with the Industry
If your practice is suffering from financial turmoil due to manual billing processes, you are predictably also lagging behind the rest of the progressing industry. With specialty-specific RCM solution, you will be able to keep up with changing ICD upgrades, updated insurer policies, and incentive programs. A specialized medical billing organization can do incontestably better than the staff in a busy medical practice.
Better Patient Service
All the benefits that come from using specialty-specific RCM service come together to provide better progress towards the primary goal of every medical practice: high-quality service delivery. For many practices, the responsibilities of finances can be overwhelming and can lead to a lesser focus on patient service. With cash flow, financial stability and other administrative tasks are taken care of, providers can shift their focus to value-based care by allocating more time and attention to their patients.
Specialty specific billing services like CureMD continue to evolve with the help of the right set of tools, technologies, and processes. This results in improved patient care and better cash flow, without compromising the critical resources of a healthcare facility.