In today’s struggling economy, physicians tend to focus more on the business side of their medical practices to ensure the sustainability of their medical practice. To improve a practice’s workflow and revenue for its survival in the long run, physicians have started shifting their focus more towards medical billing and coding. Despite this shift in the healthcare industry, many practices have gone bankrupt because of the increasing claim denial rates. It is estimated that US physicians face a loss of at least $125 billion every year because of poor medical billing. There are two main reasons why physicians face such a huge loss in practice revenue; the increasing number of billing errors made by physicians or staff members in claims and the failure of staying up-to-date with the changing rules and regulations of medical billing.
To get Ready for ICD-10 many practices have started outsourcing their medical billing tasks to billing companies, so that physicians can direct more focus towards their patients and leave the ‘dirty’ work to billing experts. However, simply handing over the billing process is not going to help medical practices reach their highest potential and squeeze maximum revenue out of the submitted claims. There are some billing companies that only assist medical practices by carrying out the implied billing tasks like code reviewing, claim preparation, claim submission and insurance follow-up. These tasks can help reduce claim denial rates of medical practices to some extent, but not assist them in turning the tide against revenue loss.
Some billing companies have taken a different approach to tackle this long term revenue loss problem. These companies offer additional services to medical practices like managing claim processing, payment and revenue generation. These added services are collectively known as Revenue Cycle Management or RCM. RCM service covers tasks like claim tracking, payment collection and also addresses denied claims, which is most likely the main cause behind 60% of missed revenue opportunity for a practice. Following are some other services offered by RCM billing companies, which makes them a better choice as compared to simple medical billing companies:
- Pursuing denied claims
Unlike other billing companies, RCM vendors keep track of both the submitted as well as denied claims. By identifying the error behind the rejection or denial of claims, these vendors can advice physicians to make the required changes before resubmitting the claim. This increases the probability of approval of future claims as well.
- Reporting and analysis
A physician needs to follow up with the billing and revenue generation process of his medical practice. RCM vendors provide timely and detailed revenue reports to the physician, informing him of the number of claims accepted or denied and the shift in the practice’s revenue generated from these claims. Regular reporting and analytics also help physicians and billers to forecast the continued growth and profit of the medical practice for the next couple of years.
- Billing follow-up
If a patient defaults on his bill, who is supposed to follow up? RCM vendors also save physicians from the trouble of tracking all patients who have yet to pay their medical bills.
In a nutshell, RCM companies have redefined the billing process of medical practices and are more suitable to handle medical billing operations as compared to simple billing companies. Moreover, not all RCM vendors charge physicians heavily for offering additional billing services, which is a plus point for small practices. In order to find a fitting RCM company for their practice, physicians must evaluate billing companies on the level of services they provide, their industry experience and use of technology.