Trends in Healthcare Billing: Healthcare Revenue Cycle Management and Global Offshore Medical Billing

Today’s healthcare delivery system is at the center of many political and social debates. The ongoing focus of these debates is often how the healthcare financial process is handled, and it is one of the many problems frustrating professionals in the billing department of hospitals and medical facilities.

Each year, $350 million is spent to submit and process claims in the healthcare industry, according to Dell, and that number is only expected to climb. Equally disheartening, HMFA stated in a late 2011 report that trends in A/R reserved for write-off and collectible A/R indicate that “the net revenues billed by hospitals are getting harder to collect.”

Healthcare facilities are facing a host of issues that complicate billing, including changes in healthcare records keeping, increasing out-of-pocket costs for patients, changing healthcare laws, changing Medicare and Medicaid policies, and the looming possibility of the Affordable Healthcare Act. Because of increasing operating costs in the medical industries, healthcare facilities cannot afford to let their A/R go unchecked.

A/R must be carefully managed, and the most effective way to do that is with improved healthcare revenue cycle management (RCM). Many healthcare facilities are looking to streamline and reduce costs by outsourcing, offshore, critical parts of their billing cycle, principally to India, a country with proven expertise in all facets of U.S. RCM.

Healthcare Revenue Cycle Management

What is revenue cycle management?

True revenue cycle management begins before the patient even visits the facility. It begins with eligibility and benefits verification including pre-authorization and enrollment. This allows healthcare providers to verify coverage in advance for every patient and also give the patient his or her out-of-pocket costs before the procedure. The second phase of revenue cycle management is implemented in the coding process. Coders can have as little as eight months of training (no high school degree necessary) to be certified. In order to increased efficiency, coders should be prescreened and required to be proficient in all the following code sets and usage guidelines: CPT-4, HCPCS, ICD-9-CM, LCD/NCD and CCI EDITS. The next phase of revenue cycle management is in the billing phase; more specifically, in charge capture and payment posting. The more efficiently billing is done, the first time, the more likely payments are to be collected. Fourthly, payments must be posted correctly and quickly to the right patient, for the right services. The final phase in revenue cycle management is receivables follow-up, a step that often gets neglected if procedures are not in place to ensure it.  In this stage, claims must be continually worked, resubmitted and processed until payment is received.

Global Offshore Medical Billing

When billing is outsourced as part of a healthcare revenue cycle management transition, compliance and cost savings both are possible. Again, coders have minimal requirements to start in the medical field. However, a diligent RCM provider can source talented and certified coders from India to produce the most accurate coding and billing support team. This will increase the accuracy and speed of processing, create costs reductions of up to 40 percent in some cases and increase compliance.

Both of the aforementioned initiatives, healthcare revenue cycle management and offshore medical billing, provide not only cost savings but increased compliance, so essential in the current regulatory environment. Audits are intensive in the healthcare industry, HIPAA compliance is non-negotiable and ADRs are on the rise. Healthcare providers cannot afford to maintain inaccurate or outdated records, billing or coding systems any longer. Healthcare revenue cycle management may be the present trend of the decade, but it has longevity because it is a solution that works and is critical to a healthcare provider’s financial well-being.