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Revenue Cycle Management (RCM) and Best Practices Adoption


For physicians, getting paid properly for the services they provide is extremely important. Between constantly changing coding rules and dozens of insurance contracts — each with its own coverage, billing and payment terms — many medical practices find it difficult to keep up. As a result, physicians too often are paid less than they actually should be which impacts their cash flow.

There is hope for improvement! By applying established revenue cycle management (RCM) best practices, most medical groups can substantially increase revenue. These best practices ensure the following functions are accomplished, including:

  • Eligibility and benefit verification
  • Medical coding
  • Charge capture
  • Payment posting
  • Accounts Receivable follow-up

The good news is that you don’t have to take on these tasks by yourself. If you engage an experienced RCM outsourcing partner, you can accomplish all of these crucial functions promptly and efficiently, even though you may have a small internal staff. An outsourcing partner will more than pay for itself by significantly increasing your practice’s insurance payments.

They can also assist with preventing inadequate documentation or coding errors (one of the primary reasons physicians fail to get paid appropriately for their services) by providing highly-trained, certified coders. Some medical practices do not to employ certified coders. As a result, these providers may not select the appropriate level of service, or ensure that the documentation supports the code billed. Some providers even deliberately down-code services for fear they will be accused of compliance violations. Failure to correctly apply code modifiers can significantly impact your practice’s profitability.

An experienced outsourcing partner will exclusively employ certified coders to code all claims; they can also conduct outside audits of their coding to assure compliance and accuracy. These coders are also capable of identifying trends in coding and communicating those trends with your internal staff which prevents future rejections. A full-service RCM outsourcing partner also provides other billing and accounts receivable management services which makes your investment more cost effective. Training is an essential component of an effective outsourcing partner/client initiative. An outsourcing partner will deploy Subject Matter Experts to train and educate your billers to ensure   they are current on billing and coding changes, as well as changes in contracts and payer policies. These experts can also train your staff to utilize workflow technologies and software that can further increase productivity, accuracy and visibility of data gained from coding.

On the technology side, your outsourcing partner can help you ensure your IT billing systems are providing the necessary management support reports, including: overall A/R, A/R by payer contract, denial rates, and variances in received versus expected payments, and trends in payments. These reports will help you spot problems early on, understand which claims require the greatest focus, and better manage staff productivity. Without robust reporting tools, a practice lacks the ability to appropriately manage financial viability. Reporting functionality is a wise investment – and an experienced RCM outsourcing partner, who can optimize your revenue cycle and maximize your financial performance, is an even better investment.

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