Common revenue cycle management challenges and how to overcome them

Common Revenue Cycle Management Challenges and How to Overcome Them

In the current healthcare scenario, efficient revenue cycle management is the crucial for medical practices to remain viable.

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With

the

multiple

organizational

and

regulatory

compliance

challenges

confronting

healthcare providers, medical billing companies need to go the extra mile to ensure effective revenue cycle management (RCM) for their clients. A transparent, efficient medical billing process is crucial to prevent claim denials and maximize financial health.

RCM refers to all the business processes involved in running a practice—from patient eligibility verification, claim processing, claim submission, and revenue generation. It is the entire lifecycle of a patient account. Here are the main RCM challenges confronting physicians today and strategies to overcome them: 

Lack of insurance verification and authorization: A problematic scenario is one where the physician treats the patient and later finds that the patient did not have health insurance coverage, or has an out-of-network plan after a service. This can result in non-payments, especially of high bills.

The solution is obtaining an insurance eligibility verification before the point of service. Reliable services are available to check patients’ coverage with primary and secondary payers by calling the insurance companies, checking via insurance web portals, and contacting patients if necessary.



Medical billing errors: Even the slightest error in a claim can lead to a denial. This can lead to delayed payments. Diagnosis codes must coincide with the procedure codes based on local and national coverage determinations. In these times of increasing patient responsibility, providers must have proper methods in place to collect payments at the point of service.

Today, more and more practices are choosing to outsource medical billing to prevent these issues. With correct medical coding and billing, a competent service provider will ensure proper and timely reimbursements. The expert staff in established companies can take care of the entire medical billing cycle – from patient registration and scheduling to payment posting, appeals and collections.

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Challenges posed by health information technology (IT): The costs of implementing electronic health records (EHRs) and other technologies have soared in

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medical practices. Managing the billing infrastructure and billing processes using advanced software is the key to efficient RCM. Outsourcing can also address this challenge. Established companies have expert staff and the necessary resources to support efficient data reporting and electronic billing using the practice’s software or their own. 

Compliance: Practices need to maintain compliance with federal and state law, and federal, state, and private payer healthcare program requirements. Failure to do so could lead to allegations of fraud, abuse, upcoding, unbundling, audits, and penalties.

Partnering with a competent medical billing company can help physicians’ practices ensure accurate, ethical coding practices as well as verify if medical record documentation supports the diagnoses and services reported on the claims submitted for reimbursement.

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Lack of a financial policy: Financial policy documentation is crucial from the point of view of the practice’s staff as well as patients. This will help patients understand costs so that they can plan ahead and pay more promptly. The physician and staff should have a clear idea about how to collect balances.

With efficient medical billing services and revenue cycle management, health care organizations can maintain their financial health and sustainability, and focus on providing quality patient care.

www.outsourcestrategies.com

Phone: 1-800-670-2809