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When is it Time to Hire a Revenue Cycle Management Service?

The thought of outsourcing work can be scary for some business owners. Will it be done correctly? Will it cost me more money? Staff too might be concerned that their jobs may disappear. We hear it all the time from clients, the sheer volume of concerns and challenges they face prior to deciding it’s actually time to hire a revenue cycle management service. Here are five of the many reasons that it might be time to work together with a fast, efficient and reliable revenue cycle management service.

What is an RCMS anyway?

In the simplest terms, an RCMS is a company that helps your business to maximize returns on your accounts receivable, by also maximizing billing and tracking capabilities. Variously, it has been described more technically as a process that doesn’t just provide medical billing services but rather, offers tracking, analyses and overall manages patient claims. It’s a complete financial management process that will help to identify gaps and opportunities to collect more, on time and at an overall lower cost due to process efficiencies.

5 reasons to consider hiring an RCM Service:

1. Staff is Spending Too Much of Their Own Time to Fix Billing

If your billings, receivables and overall accounting practices are taking up too much staff time, are falling behind, or you are experiencing significant error ratios – it might be time for a revenue cycle management service.

2. Streamline an Onerous Process

One of the complaints we hear most often is how many people are actually involved in the billing and payment of medical claims. Is it any wonder there are opportunities to streamline the process when the process is, at a minimum, 7-8 steps long? If a mistake is made at any point along the way, you’ll be faced with essentially starting all over again. This can lead to staff frustration, feelings of being overwhelmed, patient anger if claims are denied, their information is recorded incorrectly or you’ve devoted wasted time seeking to have patients pay an incorrect deductible or other similar issues.

  • If you are losing patients and/or experiencing problems with insurance companies, not because of your treatment methods but because of issues with billings, payments, deductibles or problematic claims submissions – you likely should consider outsourcing to an RCM service provider.

3. Conflict Management and Collections

We’re working under the hypothesis that most patient care medical service providers opened their practice to offer quality and much needed health care to people in need. You’re motivated by a deep-seated desire to help people and perhaps spent many years in education to perfect your skill sets. So you’d probably like to get paid too! Chances are however that you never thought of yourself as a collections agency and we’re betting your staff didn’t either. Chasing down and collecting payment for services provided long ago is troublesome and often leads to conflict – with insurance providers and/or patients. Sometimes mistakes are made, from a simple billing code error to incorrectly collecting patient information at the start of treatment. Whatever the reason, trying to fix those mistakes is time-consuming, frustrating and can lead to conflict.

  • If this sounds like what’s happening at your office right now – it could be time to implement the process of revenue cycle management.

4. Codes are Complicated!

We’re pretty sure insurance companies don’t set out on purpose to confuse us but the truth is, coding can be confusing! Every step of a medical procedure must be itemized and coded correctly to ensure reimbursement. This means from the moment a patient walks in your front door, staff need to be alert, attentive and caring but also focused. The financial implications of even the smallest of errors can result in lengthy and time-consuming disputes. A typical revenue cycle management process looks something like this:

  1. Collect patient data

  2. Verify insurance eligibility / copay if applicable

  3. Medical transcriptions and review relevant coding

  4. Billings and submit claims to insurance payer

  5. Track rejected claims and investigate corrections

  6. Follow up and monitor denials and ongoing management of resubmissions and appeals

  7. Posting of successful claims

  8. Tracking and monitoring performance against expenses

Knowing that medical billing coding errors are one of the most common reasons that insurance claims are rejected or denied, and that in excess of 10,000 CPT (current procedural codes) are currently in use, might be enough motivation alone to utilize the services of an RCMS provider. Add to that the minimum 8 step process involved in making a claim, as outlined above, and you might begin to wonder why any medical practice attempts to monitor this process themselves!

5. Improving Efficiencies and Revenue Stream

Running a medical practice is expensive. Tools, equipment, rent or a mortgage, all your supplies and of course your staffing all represent either fixed or variable costs that must be monitored and tracked. They are measured in relation to your ability to manage your practice, cover your expenses, collect from patients and/or insurance providers – and perhaps even against the desire to pay yourself a salary and/or earn some profits for your efforts. It’s a lot to ask of just one person in your office or even a team of two or three dedicated to accounts payable and receivables. Expert providers in revenue cycle management can increase revenue while decreasing the time (and money!) spent on administrative and clinical functions. Moreover, they’ll work to identify efficiencies in processes, to correct systems in order to avoid future errors in coding and to analyze and track revenue against expenses which will provide detailed reports on how to streamline processes, train staff and reduce the time it takes to collect on payments.

  • If you find yourself constantly lagging behind when it comes to revenue against expenses, it might be time to hire an RCM service provider.

Outsourcing might better be defined as “rightsourcing.” Again, in the simplest of terms, rightsourcing is applying the right resources to the right task at the right time. Running a patient centred practice means you don’t have the time to complete, track and analyze the financial side of the practice. Have everyone on your team, from the frontline employees greeting patients to the nursing and all other medical staff, all focused on patient outcomes and leave the billing, tracking and chasing to the experts. We’re Derm Care Billing Consultants and we provide exceptional revenue cycle management for dermatology practitioners across the US. Reduce your collections wait times, get paid the first time, 97% of the time, and experience 24/7 web based access to our services.

If you’ve read this far and you’re thinking I need help – then you need a revenue cycle management service!