How to Overcome Critical Challenges in Revenue Cycle Management in Healthcare
Today’s Challenges for Revenue Cycle Management in Healthcare Systems
Revenue cycle management is at the core of any health care service provider’s sustained existence and growth. The revenue cycle management process keeps track of patients and the revenue side of their treatment. Healthcare providers may make use of standalone revenue cycle management software or incorporate it into their medical appointment software or plug it into the EHR system. Regardless, it plays a crucial role and covers various steps.
Steps in the revenue management process
The hospital revenue cycle management process covers:
Pre-registration of a patient
Insurance follow up
There is more by way of gathering data, analyzing it and deriving information that helps to identify weak spots and bottlenecks. The RCM system is complex and needs a thorough grasp of how it works for operators to derive the optimum benefit and overcome inherent challenges in the revenue cycle management. <According to Advisory Board, hospitals can lose about $22 million without having an accurate and efficient RCM in place.
This is a key but often neglected area. Personnel who use the RCM software often have to learn it on their own and barely get past the essentials. Knowledge of medical coding as applicable to that region is crucial at the preregistration stage and in subsequent billing stages. This involves a learning curve for which time is required. Due to this some service providers may consider outsourcing to a revenue cycle management company. Coding a medical claim can take hours and needs knowledge that in-house personnel may lack and, therefore it may seem appropriate to hand over revenue cycle management process to expert revenue cycle management services. It also entails additional expenditure so, for the long term, it is best to introduce a degree of automation at the pre-registration stage and put in efforts to get personnel to undergo systematic training, possibly by revenue cycle management consultants. If there is no precise coding then the billing will not be accurate and it results in a loss as well as delays in reimbursement. With training your personnel can overcome bottlenecks of coding, set up the hospital’s chargemaster and capture charges in addition to being better placed to inform patients about all that is involved right before they register.
Administrators and doctors in hospitals may not be familiar with how technologies work. Technology may be implemented in a piecemeal fashion with medical appointment software, EHR and revenue cycle management software working in parallel and in isolation. There is no connect between the data in each path and that poses challenges of streamlining operations and keeping tabs. It also becomes cumbersome for doctors or those in charge of RCM to refer to each and concatenate results leading to errors of commission and omission obviously to the financial detriment of the healthcare service. The smart thing to do is to engage expert revenue cycle management vendors or get revenue cycle management solution providers to integrate all disparate streams to be usable through a single interface. If usability improves it aids efficiency and personnel will make optimal use to enhance operations across the board from start to finish of the cycle.
The gaps addressed
Coding is just one part that could pose an immense challenge in the revenue cycle management process. There are others that affect smooth cash flow.
It is vital for healthcare service providers to get their doctors accredited with insurance companies to avoid situations in which claims can be withheld on that ground. Overlooking this step can be a problem but it is easily taken care of with due attention right from the start when a doctor is going to be assigned to treat patients.
The preregistration is a crucial step in which several key information can be missed such as insurance information and eligibility as well as financial expectations of the patient and payment modes as well. One needs to meticulously gather data at this stage.
The registration step of the revenue cycle management process is another step that can face challenges due to inaccurate information and non-collection of advance payments and assigning insurance benefits as well as determining eligibility and amount.
Missing charges is another challenge. Charge capture may be done through manual input of data or automated. Regardless, some charges such as ancillary services may be missed and if recovery is attempted at a later date then a refusal is likely. Revenue cycle management consultants could possibly help address this gap through measures like claims scrubbing technology to ensure coding is done right.
Claims submitted to the insurance payer may not be in full conformity and this is also dependent on charge capture. Errors here may lead to refusal or delays. The solution is to vet each thoroughly and then track claims in real time to ensure only clean claims go through.
Accounts receivables, payments
It is often assumed that claims will be paid in full but that may not be the case. Insurance may pay less than expected and then it is for the healthcare provider to pursue the patient to pay the difference. Not paying attention to this could lead a mounting deficit. This deficiency can be overcome through the use of the right RCM system and by making the personnel aware about keeping track or, better, still, automating the system to send out a bill/reminder to patients fro such payments.
One must know how to analyze data derived from the revenue cycle management process, an area in which medical personnel may not be interested or capable of handling. It is essential that healthcare service providers know about key performance indicators and to keep watch over receivables as well as expenses and generate reports. Engaging revenue cycle management
consultants could bring your personnel up to speed in these areas. The RCM system generates and keeps on generating data that can be analyzed to derive useful information about revenue generation, reduce delays and address issues that affect processing. This is a challenge but training and familiarity through regular use of the revenue cycle management software by assigned personnel will deliver positive outcomes.
These are just a few challenges, mostly on the operational side but there will be others too such as software and hardware glitches from time to time. Retaining revenue cycle management consultants is one way to minimize and overcome challenges and ensure you get the most out of your investment in RCM software. Get in touch with OmniMD to resolve all such challenges and be prepared for future ones.
How do you choose the best medical billing company?
The medical IT industry has revolutionized in the last few years, especially since 2019. IN 2020, when the pandemic affected the world, this has bridged the gap between technology, administration, and resources. There had been a significant breakthrough, shifting from manual administration techniques to electronic health records. This would include everything from communication protocols to lab reports and from efficient medical billing systems to managing the healthcare system. In particular, this has changed the tasks of medical billing specialists considerably with the help of technology.
The billing in healthcare is very enduring for both payers and their payees. However, with the help of the best medical billing software on the market, you can use appropriate and updated medical billing strategies. While choosing the best medical billing and coding software will help the providers and practitioners simplify the billing process, resulting in increased revenue and efficiency.
Additionally, a switch to efficient medical billing software would reduce the costs of human efforts and aid in embracing electronic technologies in this sector. Instead, the providers and practitioners can generate invoices from one single interface while reducing the amount of paperwork simultaneously.
So, if you choose the best medical billing company for your practice and providers, let us assist you with the __-step guide to choosing the best medical billing company for your practice.
Determine Your Needs
When searching for your healthcare billing software, the first and foremost thing is understanding your needs. Different sizes have different requirements, and additional requirements mean additional services. Some might specialize in handling large practices, while others may have lower budgets and few physicians to operate.
While determining your size, the parameters to keep in mind are: practice budget, provider size, and accepted insurance partnerships. These parameters will decide the type of healthcare billing software that is required.
Small-scale billing services
For smaller practices, the small-scale medical billing services are perfect! They have a smaller budget and data volume, along with fewer physicians. This will provide more personalized, highly reliable, one-on-one service. This is also cost-effective and will allow your practice to save good for billing.
Physician practice Management Company
The majority of the practices require this type of size. These are the ones who will provide services to around 200 or more staff members. They are well-equipped with their expertise in the medical and coding field and handle high data volumes. They can also manage the administrative and back-office tasks.
This might get pricey sometimes, as they can charge some extra pennies for the billing and coding services. Inquire about their charge and different services, which will let everyone stay on the same page.
Professional Billing company
A large medical company will contribute extra and valuable additions to your practice. This will allow you to focus on your core tasks, i.e., patient care. These organizations will cost you more and be a little pricey for your medical billing and coding needs. However, ensure about the available plans, included features, and the additional costs.
Search for Experience
Certain medical billing companies have specific focus areas but are experts in those areas. While others might have specialty areas, they can work with various practices. The first thing to ensure while hiring the best medical billing company is EXPERIENCE. This is important because the primary cause of claim denials and revenue loss is incorrect billing and coding. This is why the practices prefer to collaborate with the top experts in the field with undivided attention and error reduction. So decide on your priorities and act accordingly.
Inquire for the cost breakup
While outsourcing essential billing services, you must not forget the cash factor! It would help if you diligently calculated the cost for each service being availed and provided. There are various ways to charge as per a medical billing company. Some might charge a percentage of the net generated revenue, others charge a flat fee irrespective of the generated income, and others go for both.
So decide how to be billed for the services and then narrow down the companies. Read line-by-line while comparing the quotations from various suppliers. Also, remember! Cost is never proportionate with quality. Have a thought!
Healthcare practices always need to abide by compliance rules and regulations strictly. It is imperative and crucial for the companies to follow these compliances. So before selecting the hospital billing software for your practice, ensure that they follow these rules and protocols perfectly.
Company Reviews Matter
A good company will have a good reputation as well. So when you sit down to negotiate, ensure that you have complete background knowledge of the same in the market. After all, Word of Mouth is the best publicity. You can also refer to the online reviews and responses that will allow you to review appropriately.
Ask them a few questions so that they can be appropriately relied upon for your medical billing requirements.
Did your last three clients provide positive responses?
How to handle the revenue loss and claim denials due to erroneous data and details?
Ask for the testimonials, references, reviews, and responses that the client has from past clients. Remember! It is crucial to be the best medical software for revenue generation and claim success.
Check Browser and Software Compatibility
Using the internal software for patient accounts and other financial tasks can hamper the usability and effectiveness of the billing software. This is why you need to search for the software and provider which will be compatible with the internal software’s key features. This would require new software to incur additional expenses. Additionally, knowing about the software will let your staff align with the user interface and workflows.
While the decision of choosing the best medical billing company is enduring and challenging at the same, stay well-informed of the company’s history in this sector. If the company has a history of claim denials and rejections, this is a clear signal of not being a good billing software. Try everyone before making the final decision.
Still, in case you feel more discussions to be done, ping us, and we are readily available for your assistance.
Top 5 Reasons to Use Integrated EHR and Medical Billing Software
The process of medical billing and practice management has always been a time-consuming task in the field of clinical practice. Undoubtedly, the EHR systems have reduced and simplified healthcare providers’ human efforts while streamlining their working processes effectively. This is why the healthcare industry is changing, and so are the health providers’ services. They have now started to look for better systems to manage their practice. A recent report says that 89% of providers have agreed that the EHR forms the core of their practice and dominates their decision-making process for selecting a management system.
And this is not all! With simpler EHR, the search and need for intelligent medical billing solutions has also become challenging which has been made easier with its integration with EHR. This integration is a boon with numerous advantages.
Let us delve into the obvious but unsaid benefits of integrated EHR with medical billing software. But before starting, let us also understand what an integrated EHR and medical billing system are.
An Integrated EHR and Medical Billing System
The Electronic Health Records (EHR) integration is defined as the process of accessing medical records seamlessly across all the electronic software solutions. For medical billing systems, this process might look a little complex and requires the HL7 interfaces to exchange the parameters like demographics, patient chart details, charge codes, encounter sheets, patient notes, billing cycle, and more. This would ensure that no data is duplicated and is seamlessly merged with the existing EHR system.
Over the years, integrated EHR and medical billing system received immense popularity. In fact, according to a recent report produced by Fact.MR, the EHR market is expected to rise up to US $23.78 billion in 2022 and anticipate a positive CAGR of 4.5% and attain a value of US$41.8 billion by 2032
The US healthcare providers lose $262 billion annually due to claim denials. The primary reasons for such claim rejections and denials are claim form errors, code mismatch, and missed claim submission due dates but are limited to these. The claim form errors constitute around 40% and 80% of medical bill errors and are the most common reason for claim denials.
These issues have majorly surfaced due to manual data input, improper software settings, and untrained staff, which is common in otherwise healthcare billing software. With the help of electronic medical billing software with EHR, the providers can:
Maintain patient data at one location.
Set notifications for claim submission as per the deadlines.
Set the coding and clinical documentation in one place.
Integrating healthcare medical billing systems into your EHR system would avoid the bulk of manual work like entering the exact details into two different programs and task redundancies, further preventing manual errors, coding errors, and more.
With a comprehensive EHR solution combined with medical billing and coding software, it’s time to improve reimbursement rates.
To avail of the federal incentive programs, the providers and hospitals must prove the meaningful use of certified EHR technology across the market. By integrating the EHR with practice management billing software, the providers are improving patient care and data security while maintaining data centralization.
The term interoperability is not only about seamless communication between external systems; it can also be used to maintain data in one centralized system and seamlessly enable the claim filing process. With the EHR billing integrations being highly interoperable, this allows data sharing with providers and practitioners with access rights. This enables the sensitive information to stay confidential while the data and its analysis allow the third parties for patient care and improvement purposes.
This interoperability reduces the data entry check-points and human errors at the most. A robust and flexible centralized system prevents security breaches while allowing providers to handle sensitive patient information without hiccups.
Reduced Billing Workloads
With an integrated EHR and medical billing software, the medical billing specialists would spend less time filing claims. With an integrated system, the coding and documentation are directly fetched from EHR, which saves the time of copying the data. The system will also prompt the physicians to complete these activities even during patient visits. This would reduce the after-visit work for the providers and billing staff.
There are many small-level hospitals and providers wherein the costs are only increasing due to these billing complications. This is why many medical billing software companies have switched to medical billing software for small businesses while easing the process of coding and documentation with claims submissions on a timely basis.
Reduce Coding Errors and Paperwork
With human comes human errors!
With the integrated EHR software with billing, the patient data will be transmitted to the billing system automatically, which will let the EMR Medical Specialists generate cleaner claims. This removes the human error chances while developing billing sheets and entering codes, enhancing the turnaround time.
The integrated EHR with billing software will also provide rest to the clinical and healthcare staff who are more or less dedicated to filling the forms and performing the claims process. This reduced workload will enable them to focus on providing better healthcare services which was otherwise not happening.
Patient satisfaction is one of the primary aims of any healthcare provider. Billing process automation and claim error elimination will improve the patient satisfaction rates for the existing patients. With the help of the insurance eligibility verification feature in billing software, the practitioner will have a clear idea of the covered services in the patients’ insurance plans at the scheduling stage.
This will be an essential step to avoid to and fros while the billing process starts. The EHR integrated billing system will help clinics inform the patients about the incurring expenses in insurance coverage which will further increase their satisfaction levels.
More time is spent on inefficient medical billing processes and systems; less time is left to devote themselves to patients. This is why an EHR integration becomes an essential component for deciding which practice management solution to choose. These solutions will allow the providers with unparalleled partner solutions, which will further modernize the existing practice and offer your patients world-class healthcare service with no hiccups in other benefits.
Practice Management Vs. Medical Billing Software – What is Right for You?
As every healthcare practice has its own needs and goals, so is its requirement. Some want efficiency to improve; some want to streamline their claims processing to be hassle-free. At the same time, others might be more interested in notifying their patients of upcoming appointments and bill the same timely. Some might want a combination of these, and some might look for all of them.
It is fine to approach your life in whatever way you want to, but when it comes to purchasing Medical Billing System orPractice Management Software, remember that you are responsible for others’ lives and health simultaneously. This is why understanding the significant disparities between the nuances of medical billing software and medical practice management software is very important.
But the one major area that is confusing for all is the debate on medical billing softwarevs practice management software. These two might look similar to a layman, but they are way apart regarding workflow. So, this article will focus on the significant disparities in the working of the Medical billing system and the processes involved in Practice Management Applications.
The Practise Management Software is the application so designed to assist the medical offices in the running effectively and efficiently. In general, the small and medium-sized provider system can manage daily operations like financial processes and administrative functions, while some organizations can utilize it for electronic medical records.
The standard capabilities of any practice management software can include the following but are not limited to:
Patient appointment and its scheduling
Tracking charge capture
Performing the billing procedures and claim processing
Payment processing from patients, insurance providers and third-party providers
Generating staff reports
As PMS simplifies patient data management, the adoption of these systems has grown drastically over the last few years. According to Grand View Research, the US$12.9 billion market size value of PMS in 2019 is expected to witness an annual growth of 8.8% by 2022 to 2030.
There are three different ways to install the software: desktop-only, client-server, and Internet-based.
Desktop-only software: This can be used on a single computer by the few who can access the system.
Client-server software: This can be accessed by multiple users with data sharing and on-site server access that the practice has to purchase or lease.
Internet-based software: The user can access the internet and eliminate the server purchase pre-requisite, but this can hamper the security as patient data is accessible externally.
The Practice Management Applicationsalso manages big data like ICD codes and procedures, third-party insurance providers, medical procedures, and providers.
Pros of Practice Management Software
The software is responsible for helping various departments in any practice as mentioned under:
Front Desk Staff
The Front Desk Staff will not duplicate the insurance card. Instead, the staff will scan the card to capture the relevant information. This will save time and human efforts at the same time.
The billing staff can submit and re-submit the insurance claims quickly as that software automates the tasks. This would save time and boost cash flow efficiently.
The physicians can validate the ICD codes for the patient diagnosis and with the insurance company before ordering the same. Additionally, this software can ease the other administrative functions required while running a practice. This will allow the practitioners to continue their practice at ease without bothering about their different roles.
What is Medical Billing Software?
The Medical Billing Software will handle all the tasks from where the patient appointment is scheduled until the time the patient finishes the telehealth session with the practitioner. Medical billing services are an essential feature in medical practices, which is vital to obtain when the patient appointment is set up, insurance is claimed, claims need to be re-submitted, and more.
This is why the practices with in-house medical billing specialists also prefer to use their medical billing services.
Ever been caught in a situation like when to send the bill, when the second or third notices are sent for missed payment reminders, or view the generated billing reports all at once? The medical billing services will come to your aid.
Major Disparities in the PMS and Billing Software
The primary difference between practice management software and billing software is that the PMS is responsible for managing the administrative side of the practice, and the billing software takes care of the clinical element of the practice. The PMS maintains the facility management records in digital format and is not shared externally. On the contrary, the medical billing specialists need to share the individual patient data and records with other medical professionals and practitioners.
So which are the tasks that you need to handle with software? Most providers and practitioners use the software for administrative and clinical uses. This is why the decision to use the software must be decided based on compatibility. This will help the software end-users ensure that the departments are working in sync and data consistency is maintained.
Numerous vendors in the market offer Practice management billing software: an easy and seamless integrated software. Try one of these software as per administrative or clinical requirements. At times, these integrations reduce the human efforts, which in turn enhances the provider’s performance and management at par with the competition.
In Other Words
It is not uncommon to summarize the medical billing software with practice management software. The billing software and system handle the creation and maintenance of the healthcare services provider. The PMS focuses on the revenue flow and patient support features like scheduling, patient charting, medical records, and more.
Medical practices of all sizes find it appropriate to use practice management software that helps billing specialists manage and maintain their growing and ongoing practice. Additionally, this software is ICD-10 compliant, which is why they are more reliable and secure.
Still, confused about the software to choose for your practice? Schedule an appointment with us, and we will assist you hereon!
Author : OmniMD Post Date : September 16, 2021 Total Views: 1196
Increasing the number of new patients while retaining current patients is vital to the success of any physician’s practice. But, unless that practice receives steady, profitable cash flows throughout most revenue cycles, they may be unable to stay operational.
Even before the COVID-19 pandemic, the dilemma of whether to do in-house medical billing or outsource medical billing beleaguered many physician-owned practices. Now that the healthcare industry is inundated with COVID patients and people suffering long-COVID symptoms, physicians are discovering the numerous benefits of relying on billing partners. According to Grand View Research, the medical billing partner market is expected to exceed $19 billion by 2026. That’s a nearly 12 percent annual growth rate!
How Can a Billing Partner Improve Medical Revenue?
Ensures Accurately Coded Claims
What is fueling this rush by physicians to find the best medical billing partner they can depend on for superior service? One of the leading reasons behind the skyrocketing billing partner market involves the necessity for filing claims correctly. Unless claims are coded accurately and error-free, they will be returned and the physician will suffer an interruption in cash flow.
An estimated 80 percent of medical claims and billing documents contain at least one error that prevents physicians, clinics and hospitals from getting paid. With over 80,000 diagnostic and procedure codes to comb through, medical assistants and physician staff simply don’t have the time to consistently submit 100 percent accurate claims. Unfortunately, the cycle of submitting claims, getting back rejected claims, finding and fixing errors and resubmitting them can force providers to wait for months before receiving payment.
A professional medical billing partner provides trained, knowledgeable billing and coding specialists who’s job is to do one thing: submit correct claims the first time. This allows physicians and their staff to focus solely on patients and running the office as efficiently as possible.
Handles the Collections Process
One of the most time-consuming tasks of a physician’s practice is collecting past due payments. Doctors can tell you from experience that simply sending past due notices is ineffective for settling a past due bill. Moreover, when doctors decide to sell a debt to a collection agency, they lose most of that revenue.
Billing partners take care of collecting past due payments. They employ individuals who specialize in collecting debts by working one-on-one with patients, verifying addresses of patients who have moved and informing patients of payment options available, such as credit cards, other types of insurance or local social agencies.
Increases Revenue by Adhering to Insurance Regulations
Major insurance companies, including Medicaid and Medicare, are constantly changing guidelines regarding what treatments they cover, patient eligibility and how much they will pay for certain procedures. Trying to keep up with the constant deluge of modifications to insurance rules is literally a full-time job that a busy physician’s office finds difficult to manage properly.
A medical billing partner stays up-to-date in real time to changes made by health insurance companies. This means claims won’t be rejected for including obsolete or incorrect data. In addition, many updated insurance guidelines for Medicaid or Medicare come from changes made by the federal government. Continuous noncompliance with federally mandated adjustments may result in losing compensation provided by Medicaid and Medicare.
Is Outsourcing Medical Billing Right for Your Practice?
Consider the following summary of the benefits of hiring a medical billing partner:
Significantly improves cash flow and revenue by eliminating costly errors and claim returns
Reduces overhead expenses
Less expensive than purchasing and constantly upgrading medical billing software (software cannot manage debt collections nor handle problems best suited for human-to-human contact)
Professional medical billing partners provide detailed monthly reports regarding claims sent, collections, payments and other important items
Allows physicians and staff to spend more quality time with patients
Ensures physician practices comply with ever-changing federal insurance regulations
Call today to learn more about how a medical billing partner can give the advantages you need to make your practice a long-term success.
Author : OmniMD Post Date : April 1, 2021 Total Views: 1406
Denials can be a massive thorn in a practice’s side. Chasing claims and resolving denials can be a huge time suck for your billing staff. Today on the blog, we will share the top 10 most common denials for physician practices.
Verifying Eligibility & Benefits:
A patient who is either ineligible or has no or expired insurance coverage will result in a denied claim.
Missing or Incorrect Information:
The most common mistake is missing critical information when the claim is submitted, e.g., missing service code, fields left blank, wrong plan code, etc. Due to sheer negligence, sometimes we make silly mistakes, like the birth year 1957 can be written mistakenly as 1975.
Incorrect Patient Demographics:
Anything in the basic patient demographics can be wrong, ranging from a patient’s nickname instead of a full name on the file, wrong DOB, and incorrect insurance ID can straightforwardly lead to a denial.
Often, we fail to check eligibility and do not call payers to determine the coverage requirements. The patient’s insurance policy determines what’s covered and what’s not.
Pre-certification and Prior Authorization:
At times, especially when diagnostic studies and complex procedures are performed, a pre-authorization (MRI, CT scans, etc.) or pre-certification as indicated must be obtained from the payer based on the patient’s plan, failing which would lead to denials and is one of the most common causes of denials.
Submitting to the wrong insurance company:
Having the wrong insurance on file and submission to the wrong payer will lead to immediate rejection.
Timely and Appeal Filing Limits:
It is not uncommon for things to fall through the cracks—especially when you’re busy. There is a set time window following service for a claim to be reported to the payer. If you miss the train, the claim is bound to be denied. Similar is the case with appeal filing window limits for previously denied claims.
Incorrect Place of Service:
Each place of service has a two-digit code, and it is mandatory to specify where the service was performed (IPD, OPD, nursing home, ER) to get paid accurately.
Either knowingly or unknowingly, resubmitting an already submitted/approved claim is bound to be rejected and can be considered fraudulent.
Correct coding is essential for claims, so using the wrong CPT code, unmatched ICD-10 code, or wrong or no modifier, etc., can cause rejection. Also, coding is continuously evolving, and it can be easy to use and outdated code.
Now that we’ve identified the biggest culprits, you know what to watch out for and where it pays to tame time to check your work. OmniMD has created a Clean Claim Checklist to Reduce Denials to help in your claims process. Click here to download!
If denials are a concern for your practice, OmniMD would be happy to help. Click here to schedule a call.