The definition of revenue cycle management is simple but the implications for your practice can be significant. Understanding what Medical RCM is can be the difference between earning the revenue you need to thrive as a practice or operating on thin financial margins. Revenue Cycle Management, or RCM, is the function that all practices, groups, and health systems have in place to, at a minimum:
Of course, actually collecting that revenue is rarely that straightforward! Managing patient expectations and interactions, working denials, and ensuring that your organization collects what it is owed is much more complex than 3 bullet points. That complexity is the reason many healthcare organizations choose to outsource their medical billing.
Operating a healthcare organization becomes more complex with every passing year. There are new regulations, coding updates, changing payer rules, and performance measures that can significantly affect reimbursement.
Deciding to outsource medical billing simplifies an organization’s administrative process and provides the highest return on investment for their revenue cycle management dollars.
Healthcare organizations know it’s time to outsource medical billing if or when they are not collecting the revenue that they should be. Early warning signs that you are on the path to sub-optimal collections can include:
The work of a medical billing company starts at patient registration and continues through until claims are paid
When healthcare organizations outsource medical billing they are outsourcing much more than just the submission of claims.
With Medusind, the work starts at the beginning of the patient visit lifecycle: the appointment. Whether it’s a new patient that was just registered or an existing patient who has set a new appointment, we verify that patient’s insurance eligibility and benefits. The results are near-instantly and automatically populated into the proprietary RCM technology we provide for your healthcare organization.
Providers then treat the patient and, depending upon level of service, either generate a superbill or provide clinical documentation to be coded onto a superbill. It’s important to point out that with Medusind, you can keep your EHR! If you like your electronic health record or clinical software we want you to keep it! Our RCM technology will seamlessly integrate with it.
Next, the superbill is scrubbed and validated against our rules engine to ensure the claim is clean and has the highest probability of being paid on the first pass. Then, the claim is submitted to the payor and the response to the claim plus any other electronically available information is populated into MedClarity, our RCM technology, with total visibility for the practice.
Medusind then works denials and handles all interaction with the payer to be sure the claim is paid to contract and the practice collects what is due.
A medical billing service can increase revenue for your practice by identifying revenue opportunities that are not obvious without the right RCM technology and without the human expertise to find these opportunities.
In the form of a cost savings, it is expensive to hire certified billers and coders at healthcare organizations with one FTE averaging $35,000 per year in salary alone. Partnering with a medical billing service helps reduce the ongoing need to hire this type of help.
It’s important to note that just because you partner with a medical billing service doesn’t mean the billing department will be losing their jobs. It’s important for continuing practice operations to have employees with knowledge of billing and collections to serve as a liaison to the billing company. And, where efforts were 100% focused on billing, that labor can now be re-focused on patients.
Small practices of all specialties have much to gain when partnering with a billing service. As previously mentioned, the lack of appropriate technology (or training on the existing technology) and lack of knowledge around the latest medical billing rules and regulations can make maneuvering through the revenue cycle difficult for smaller practices.
We see that in many smaller practices there are not enough employees to effectively manage all aspects of the practice all of the time. By outsourcing the billing and collections efforts you’re allowing your existing staff to focus on what matters most- your patients.
The time to outsource your medical billing is when you recognize or get the feeling your organization isn’t collecting the amount of money it should be, plain and simple.
Whether there is a clear need for revenue cycle help or it’s something your healthcare organization is curious about we are happy to provide an analysis of your current metrics to understand how much improvement in your revenue can be made. Don’t hesitate to contact us with any questions about medical RCM, learn about our medical billing service, or hit the contact page to request a free practice analysis.
Tell us about your business or organization and we’ll connect you with a Medusind expert who can show you the products in depth, and answer any questions you have. See how a provider, office manager, or biller use Medusind to empower their practice.