Why Proper Revenue Cycle Management Is A Necessity

What is Revenue Cycle Management? The Healthcare Financial Management Association (HFMA) defines revenue cycle as "All administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue." A truly comprehensive revenue cycle solution is more than just medical billing services; it includes the entire life of a patient account from creation to payment and should include the following benefits and services, as described in our unique “8 Step Revenue Cycle Management Process”:
  • Maximize Productivity
    • Scheduling efficiency
    • Resource utilization
  • Charge Capture
    • No missing fee slips
    • No missed charges
  • Coding Accuracy
    • E&M level of service
    • Dx linking
    • Modifiers
    • Charge order
  • Clean Claims
    • Insurance eligibility
    • Pre-claim edits
    • Referrals & authorizations
    • Timely filing
  • A/R Management
    • Insurance follow-up
    • Proper adjustments
    • Denial management
    • Appeals
  • Patient Collections
    • Copay coaching
    • Statements
    • Dunning letters
    • Follow-up phone calls
  • Smart Analytics
    • Reporting
    • Contract payment analysis
    • Trending and forecasting
    • Decision Support
  • Process improvement
    • Payor contract negotiations
    • Coding improvement

By helping properly manage the practice’s revenue cycle, physicians can devote more time to providing patients with the thorough care they deserve rather than spending time on administrative work.

Health Prime International has been providing revenue cycle solutions for almost 12 years to nearly 1,500 physicians in more than 55 specialties, so we know that proper management of your revenue cycle is an absolute necessity that will pay for itself multiple times. Many physicians who ask us for help had been finding themselves concerned about their practice staff’s ability to manage day-to-day operations while struggling with the annoyances of medical billing. At times, some of these practices had simply outgrown their own billing department. Today, more than ever, physician practices are faced with a growing list of challenges as they strive to juggle the day-to-day mission of providing high quality health care to their patients with the constantly changing hurdles imposed on by public and private payors.

To really understand if you would be a good candidate to outsource your revenue cycle operations, ask yourself the following questions:

  • Do you need to upgrade your billing and collections system, practices and processes?
  • As your practice is growing, do you notice yourself trying to keep up with billing and credentialing?
  • Are you unsure about whether you are using your resources to the fullest to receive the greatest amount of net revenue?
  • Do you find it hard to find and keep qualified billing employees?
  • Are your average days in A/R more than the national average of 37 days?
  • Is your billing staff too busy to resolve denied claims?
  • Are you worried about employees incorrectly processing payments?
  • Would you be able to deeper analyze your financial performance?
  • Are you having a hard time keeping up with compliance regulations and government incentives?
  • Would you like to spend more time with more patients and less time on back-office functions?
  • Would you like to optimize your overall cash flow?

In order to get the most out of medical billing companies, here are some tips:

  • Choose a company that can tailor a billing solution that fits your needs and can support your practice.
  • Ensure that the solution can support Meaningful Use guidelines, other regulatory changes and is ICD-10 ready.
  • Ensure that the company that will show you results thorough comprehensive and transparent reports.
  • Choose a company that has a strong reputation and can provide references upon request.
  • Hold regular meetings to ensure that you will see results and watch your practice financially thrive.

If you still feel that handling your billing in-house is a more financially sound option, ensure that you tackle these lessons I've learned through my experience:

  • A loss of medical practice income up to 10% can occur due to administrative errors.
  • Rejections and underpayments are usually a result of complexity of claims, data entry errors and coding errors.
  • Follow-ups can help originally rejected claims get paid 95% of the time.
  • About 35% of calls from patients are regarding billing issues.
  • Only 35% of charges on average get entered into the system within 24 hours. Remember that it is considered best practice to get all charges entered within 24-48 hours.
  • Almost 50% of practices billing in house have only one person handling denial resolution. That is an extremely difficult task for one person to handle in addition to other administrative duties.

An important takeaway is that a practice without utilization of a proper Revenue Cycle Management solution jeopardizes the ability to thrive financially and limits the time you can actually spend practicing medicine. These administrative headaches can all be resolved through modern technology solutions. With ICD-10, Meaningful Use and always changing healthcare rules and regulations, it is almost necessary to have a complete technology solution that can support all kinds of billing issues. By outsourcing your Revenue Cycle Management, you will undoubtedly have more time to provide high quality healthcare to your patients without having to continually worry about preventing revenue leaks and optimizing your bottom line.


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