According to industry standards, Revenue Cycle Management (RCM) goes beyond the basic function of billing to comprise claim processing and denial management, patient payments, medical coding and billing, and revenue generation. Hence, it will not be an understatement to suggest that RCM is the lifeline of any physician practice. Unfortunately, many healthcare professionals mistake RCM as an equivalent to their practice medical billing company.
The enhanced revenue stream primarily depends upon time management and the practice workflow that initiates at the time of registration where patient insurance eligibility is determined and co-pays are collected. It ends with correct coding of claims using ICD-10 and sending them out on time. An efficient billing system is also an important benchmark of a successful revenue cycle management. This can be achieved by implementing the right EHR and Practice Management system or revenue cycle management outsourcing to a reliable vendor.
The revenue cycle begins the moment patient calls to schedule an appointment with the practice. The front-desk staff must necessarily be adept in dealing with the new and returning patients. In case there is a new patient, it is essential to collect and verify patient insurance and demographic details accurately. In case you get these details wrong, your claims will be rejected right away. Similarly, for a returning patient, you must check for any change in details and remind them of their past non-payments, if any.
Patients’ clinical documentation should be complete and according to the requirements of CMS guidelines. You must integrate the documentation process into daily decision-making process to ensure that the patient record is complete and compliant with ICD-10 coding standards.
This is the most critical phase of the revenue cycle management workflow. The physician will be paid for the services provided as per the information shared on the Superbill, which should provide details of the diagnosis and procedures performed on the patient, along with correct CPT and ICD codes.
Collecting co-pays at the time of registration is usually the best front office practice. However, in case of patient emergency or peak hour rush, patients can be asked to pay before they leave the practice.
Physicians should have CMS certified EHR, vaccine management administration system and Practice Management System in place that will essentially enable them to code with ICD-10. Owing to the complex nature of the codes, practices should hire professional coders to ensure claim processing on the first submission.
Creating an accurate claim is the most crucial phase of the workflow. The revenue of a practice depends on the acceptance of claims submitted. Hence, it is highly important that the claims have accurate details and is submitted on time.
Given the highly competitive environment as of today, claim denial is an impeding concern that healthcare providers have to face. Delayed reimbursements due to claim denials weigh heavily on the revenue stream of the practice. Hence, to avoid any delays, it is imperative that the providers, front desk staff, coders and billers, and clinical staff should provide accurate details, which are required to be mentioned in the claim.
The revenue cycle management process completes when the providers receive payment for their services. In case of denied claims, the provider will be informed through ERAs of the necessary details. Then begins the cycle of claims processing, which is both time consuming and resource-intensive.
Under the HITECH Act, providers implemented certified EHR and Practice Management systems at their practices, which resulted in the automation of their Revenue Cycle Management. Technology has amplified the efficiency of practice workflow and improved patient care manifold. Advanced automation of the revenue cycle solutions enables providers, front desk and clinical staff, and coders and billers to not only save time but also increase performance levels.
Limitations: In-house management of practice revenue does not end with a perfect EHR software and PM solution. There should be expert coders and billers who can provide you with optimal results, by making use of the available technology. According to AHIMA, it will require 16 hours on average to train your staff in ICD-10-CM, 24 hours on ICD-10-PCS and 10 hours on practice implementations. Moreover, a professional code can cost you around $50,000 per annum.
With ICD-10 on the horizon, it is smart to not take any chances with your practice’s RCM. This is perhaps the most significant change in the healthcare industry since 1979. It is expected to affect literally every domain of the practice – particularly the healthcare RCM function. The drastic increase from 17,000 to 140,000 codes is bound to impact clinical and billing systems of any practice. Hence, in order to manage this change, physicians, coders, and billers will require greater understanding and comprehension of ICD-10 codes to save their practice from huge losses.
CCMS has estimated three major loss streams that practices may incur if their billing is not prepared for the forthcoming challenges of ICD-10:
These numbers are relevant to a healthy practice with a relatively sound revenue stream.
Although ICD-10 will impact hospitals and practices alike, regardless of sizes and scope, small and medium practices in particular as expected to face the toughest of times in terms of coping with the revenue loss. In 2014, AMA carried out a researchto identify the estimated cost of ICD-10 implementation for practices:
This is why it is advisable for the practices to outsource their medical billing to an experienced and reliable RCM company. Black Book Rankings Survey 2014 further indicates that practices that have outsourced their medical billing have reported 6% increase in their revenue; while 90% of solo and small practices are considering outsourcing their RCM before ICD-10 deadline.
CureMD offers its customers complete end-to-end Medical Revenue Cycle Management solution. We understand your RCM needs. Our teams of certified coding and billing professionals work tirelessly to boost your reimbursement streams and streamline your revenue workflows. We strive hard to ensure:
RCM services: Our RCM solution is unmatched in the industry. We offer: