As a healthcare provider, you do not need to outsource any of your revenue cycle management activities, provided that the following are all true:
1. All of your revenue cycle activities are completely efficient, productive and up-to-date!
2. You are totally certain that your facility will not be hit by declining revenues and negative profitability due to the transition to ICD-10.
3. You are confident that your RCM technology and processes will enable you to accommodate upcoming regulatory requirements updates, such as participation in accountable care organizations (ACOs).
However, if you are not confident of these three activities then your business is at financial risk, and you should consider working with an experienced and knowledgeable outsource partner.
In a recent survey by Black Book, a technology and services market research and opinion company, 87 percent of the medical practices surveyed, reported that their billing and collection systems were inefficient and needed upgrading. If you fall into that blessed 13 percent category where everything is just hunky-dory, you are all set to go.
If you fall into the 71 percent of physician practices – reported in the same survey — who ARE experiencing financial hardships, you may want to consider outsourcing some or all of your RCM activities. What can you expect by outsourcing your RCM?
The largest benefit will come in the form of immediate resolution to the majority of your RCM challenges. Outsourcing your RCM can provide a wide range of services that leverage experienced people, processes and technology to provide immediate operational and financial solutions that will maximize your reimbursements and reduce expenses. These services include:
Eligibility & Benefit Verification
In the absence of proper eligibility and benefit verification, countless downstream problems are created — delayed payments, reworks, decreased patient satisfaction, increased errors, and nonpayment. To avoid these problems, an outside expert service can be employed to remotely host a centralized eligibility unit for medical practices. This solution can deliver an expert staff and technology management with the objective of delivering high-quality, cost-effective patient insurance eligibility and related services.
Medical Coding
High quality coding services are essential to the survival of a medical practice, especially with the upcoming transition to ICD-10. A team of experienced Certified Professional Coders, who are ICD-10 trained, and professionally accredited, will have the proficiency to meet any medical practices coding and billing needs.
Charge Capture and Payment Posting Services
This solution should automate the receipt, processing and posting of all RCM paper documents including charges, demographics, insurance payments, patient payments and correspondence. Services within this solution should include:
* Patient Registration
* Charge Entry
* Payment Posting
* Denial Posting and Management
* Account Reconciliation
* Refund Handling
Credit Balance Resolution
Credit balance backlogs should be prioritized and processed. Incorrect adjustments, erroneous credits and misuse of debit codes can make the credit balance task quite challenging. A professional approach is the key to resolving credit balances, many of which become account corrections as opposed to actual refunds.
In conclusion, if everything in your practice’s revenue cycle management is “ship shape,” then you have no need for professional outsourced RCM assistance. However, if you are one of the thousands of medical practices who are struggling with daily financial hardships, you may want to consider outsourcing as a definite solution to your RCM challenges. Visit www.gebbs.com for solutions!
