Revenue Cycle Management is the primary component of a successful medical practice. Regrettably, professionals are often forced to deal with difficulties with RCM as a result of disturbances in the communication process. In addition, many doctors have difficulty reconciling the notion that they are also business people with their role as medical experts. So, they are always looking for new ways to improve the way their practices work.
These problems may be troublesome on a limited scale and a broad one, and they provide areas of potential for doctors to increase their income stream. First, look at the problems that specialists have with how the healthcare system handles revenue cycle management.
Challenges for Specialists in Revenue Cycle Management
The following are the most common RCM issues doctors face. These difficulties may be troublesome on both a local and a large scale, and they provide doctors with opportunities to increase their earnings.
A/R follow-up late or nonexistent
If there isn’t careful follow-up on A/R, many practices leave money on the table, which does seem odd, but it happens when there’s no attentive follow-up on A/R. When collections aren’t done on time, follow-up isn’t done consistently, and insurance coordination isn’t done right, money “leaks” away slowly.
In addition, physicians need to be cautious not to write off too much of their patients’ accounts receivable since this might indicate that their revenue is more significant than it is. This practice should be stopped immediately if it is revealed to be a stated practice of the office manager or if it is found that this is a company’s current policy.
Even though it might seem like a good idea in the short term, it is not good to keep doing it in the long run.
Capturing the Right Amount of Revenue
Capturing the proper amount of income for the care delivered is critical to maintaining the integrity of the revenue stream. In a nutshell, if the appropriate dollar amount is not submitted, a physician runs the risk of not being appropriately compensated for the services that they have rendered. But compared to regular care providers, experts may be more likely to be hurt by methods that don’t get enough charge.
This procedure is challenging to complete when it comes to specialist treatment for the simple reason that charge entry procedures and pricing plans are not quite as clear. In addition, the treated conditions might sometimes be more complicated. Lastly, the clinician may spend more time talking directly with the patient during the session.
Due to the large number of experts who work on value-based care protocols and bundled payments, it is also possible that more than one system will be used to collect information.
Pre-Authorizations for Medical Treatment
Due to the unpredictability of insurance coverage in specialty medical fields makes, obtaining prior permission before providing therapy to a patient is necessary. But dealing with pre-authorization is a process that takes a lot of time, as an expert or manager of a specialty care group will confirm.
Even worse, if anything is done wrong while filing a claim with a payer, the patient will experience annoyance and delay receiving treatment. If your practice manages previous authorizations manually, it may be time to investigate the possibility of automating this process. Automated procedures for prior approval could free up a lot of administrative work and cut down on lost revenue.
Drug and Treatment Pricing and Payer Contracts
Experts are not unheard of in providing therapy that incorporates several of the most innovative medications and treatments currently available. But on the other hand, more modern and creative levels of care may also come with higher price ranges on the spectrum of costs.
Your medical practice must be aware of the most recent medication and treatment prices following particular payer contracts to guarantee that it will adequately compensate for certain service types. Payers also have to make changes to reimbursement rates because medical treatments are always getting better.
For instance, CMS revises the prices of its prescription reimbursements every three months.
Maintaining Compliance in Revenue Cycle Management
Every provider has the problem of ensuring that their practices are in line with applicable regulations, but experts may have an even more significant burden. Most of the time that specialists spend dealing with rules and procedures, such as referral procedures and prior approvals for treatment, might be spent treating patients. As a result, failing to meet critical regulatory criteria could significantly affect revenue cycles.
Even something as seemingly minor as placing the health information of a single patient in jeopardy might result in a myriad of problems that cut into income. For example, if a HIPAA violation was done “unknowingly,” one hundred dollars could be given a civil penalty.
Using the Correct Medical Coding Methods
Accurate medical coding is one of the most challenging aspects of the financially demanding process of providing specialized medical treatment. Coders have to stay up to date on how specialty areas and specific therapies must be recorded in medical billing and how the rules change over time.
If the programmers the specialized depends on are not effectively monitoring standards and modifications, then revenue loss is very sure to occur. Standard practice for specialists depends on outside medical billing or revenue cycle professionals rather than employing staff members in their own offices. Most of a specialist’s workday is spent educating oneself on the most recent ICD standards and the constantly shifting coding criteria.
In a nutshell
RCM Matter can assist start-up businesses, specialized doctors, and hospitals in rapidly entering the market by providing superior service and customized solutions. RCM Matter has extensive experience in the field. We can construct a bespoke healthcare RCM from the ground or improve the functionality of your current system.