Revenue cycle management, or RCM, has become a hot topic for healthcare providers and organizations over the last few years. With the introduction of EMRs, ICD-10, and MACRA, establishing and maintaining an efficient revenue cycle has proven challenging yet increasingly vital to operations.
An effective RCM solution can pinpoint exactly where your claims money is getting trapped in the revenue cycle. Here are four common reasons why your money remains outstanding.
1. Delayed Billing
If you can't get the claim out the door in a timely fashion, then you're, unfortunately, already behind from the get-go. Since curating an accurate and clean claim requires data from several departments, it's imperative that each department is meeting the predetermined billing schedule (i.e. chart documentation completed within 24 hours of DOS, coding completed within 24 hours of chart documentation, etc.). For example, if you've been successfully dropping claims within 10 days of the date of service, imagine the financial impact of cutting that down to only five days.
2. Underwhelming Upfront Collections
With the jump in high-deductible health plans (HDHP) — estimates suggest that nearly one-quarter of employees were enrolled in HDHPs through their employers in 2015 versus only 4 percent in 2006 — there is much more revenue at risk. If you are not collecting those funds at the time of service, the cost and difficulty associated with collecting those fees after the patient leaves frequently increases exponentially.
3. Inadequately Trained Staff
While technology, like EMRs and voice recognition software, can streamline the documentation and billing processes, undertrained staff can act as a major hindrance as well. As technology becomes more widely used in healthcare, the need to have adequately trained staff rises in tandem. From properly capturing or updating patient demographic information to coding to the highest payable code supported by the clinical documentation, your staff plays an integral role in establishing an efficient claims cycle that minimizes the days in accounts receivable (A/R) and maximizes reimbursement.
4. Lack of Monitoring
Although technology has greatly improved the ability to monitor the life cycle of a claim, many providers may not be fully utilizing these tools. Reports such as aging A/R and A/R by payer or facility can quickly pinpoint trouble spots before claims age out, resulting in costly write-offs and lost revenue. Failing to monitor claims can also undermine your ability to catch technological errors too. For instance, claims may bill out to the primary insurance, yet fail to drop to the secondary or tertiary payer, essentially leaving claims money "stuck" and aging in the process. Identifying these glitches as soon as possible is key and can be achieved through more strict monitoring.
The Solution
Our revenue cycle management solution pinpoints exactly where your claims money is trapped. Our RCM tools, developed over many years by the biggest names in healthcare, can identify the 20 percent of unpaid claims that will return 80 percent of the money your practice is owed.
Moreover, most revenue cycle management solutions require you to outsource the services to them. That's where this toolkit differs. We give you the tools to determine how many employees are required to collect that money and how to organize them into efficient teams to get it. After all, nobody knows their finances like you. Request a demo to get started.
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Where does your claims money tend to get trapped? Do you use a revenue cycle management solution? Please join the conversation below.