RCM processes that a medical billing vendor must offer

The key behind a financially successful medical practice is the effective and efficient use of its Revenue Cycle Management (RCM) model. RCM involves all steps related to claim processing management and revenue generation. Looking at historical trends, revenue cycle management has always been a priority for physicians but the recent regulations imposed by CMS and HIPAA are making RCM unmanageable for many.

Due to this dilemma, many practices have considered outsourcing the entire RCM process to medical billing vendors, who are more equipped to handle the process.

The problem with outsourcing for many

The next question that arises, and one that puzzles many physicians, is that if outsourcing medical billing is the best solution for both small and medium practices, why are many practices (which have outsourced the service) still not generating more revenue?

Revenue Cycle Management-CureMD

The reason

Well research all points towards the RCM vendor selection process. It turns out that if a wrong vendor has been selected for the job, or a practice fails to maintain a proper relationship with its vendor, the results can be disastrous. Practices aiming to increase their revenue can go bankrupt if physicians fail to follow the appropriate guideline or steps while choosing their Medical Billing vendor.

The solution

The ideal medical billing vendor should not only have the relevant experience in Revenue Cycle Management, but should also offer a greater ROI than the cost required to outsource the process. Here are some RCM processes that practices must ensure their vendor is offering,:

  1. Follow-up:

Claim processing and submission is not all that is required from medical billing vendors. Billers must keep regular follow-ups on the claims that have been submitted to insurance companies for further processing. Follow up time differs for different insurance companies. Some process claims within 15 days while others take as long as 40 days. Some practices fall in bankruptcy by the time they realize that their vendors have only been submitting claims and keeping no tabs on what became of them afterwards.

  1. Regular reports to provider

Billing vendors should establish a strong relationship with the practice, and keep the latter updated of submitted claims through regular reporting. The reports must be shared at regular intervals (eg: every 90 or 120 days). These reports must include the percentage of accounts in receivables, as well as a breakdown of payers and providers with accounts in each category. The reports must also include a breakdown of claim denials and rejections, along with their causes.

  1. HIPAA considerations

The billing vendors must also keep up with the latest HIPAA regulations announced by CMS. They must also provide the practice with Risk Assessment and Measures to remain compliant with HIPAA.

There are many other RCM processes that billing vendors offer including, but not restricted to, performance guarantees, technology interfacing and address inefficiencies and shortfalls in getting fully paid on a timely basis. However, if a practice plans on outsourcing medical billing, it should be aware of billing vendors that try to trap practices by fooling them into signing misleading long term contracts. This way practices would lose a lot of revenue if they decided to end the contract early, even if the cause was poor vendor performance.

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