Quest Diagnostics recently conducted a national survey asking respondents about their biggest pain points when it comes to the physician billing process. Over half said they were concerned with keeping up. This includes staying current with evolving requirements from payers (35%), and not having enough time or staffing for billing (31%).
The evolving requirements from payers pose a challenge for physicians who find themselves facing declining reimbursement rates and the narrowing of provider networks. It can be difficult to stay current with payer contracts, to know how quickly they pay, and to keep pace with changing reimbursement rates for commonly-used codes. Knowing the codes can also be a challenge, ICD-10 codes being a prime example. The Centers for Medicare and Medicaid Services and the Centers for Disease Control and Prevention have added hospital inpatient procedure codes and about 1,900 ICD-10 diagnosis codes alone for fiscal year 2017.
Having enough help
Many offices have a receptionist, an office manager, and a medical assistant. But when it comes to keeping up with billing and reworking claims, physicians say they don’t have enough employees to focus on these tasks in addition to everything else that goes into running a practice. The experience and expertise of support staff also makes a difference when it comes to the efficiency and accuracy of their billing practices.
Get a hold of the process
Some practices cope by adding technology that lessens administrative tasks like scheduling or outsourcing the billing all together. Many see revenue cycle management (RCM) as an “ounce of prevention” for these revenue problems, and an alternative to in-house billing.
With in-house billing, practices need adequate practice management (PM) software to keep up with balances and to send bills. Someone must respond to rejected and denied claims in a timely manner, and they must stay on top of regulatory changes. It can be quite time consuming.
A full RCM solution offers the ability to track patient visits from registration and scheduling, to patient visit and through final payment. These tasks are usually handled by a service for a percentage of collections or for a subscription fee. One advantage is that it automates numerous functions so that physician staff may focus on other work. Some of these tasks can include reminding patients of appointments, or performing auditing functions for the practice. The RCM service handles collecting patient payments and claim reviews from insurance companies. It can help prevent many of the problems physicians typically deal with in the revenue cycle. When combined with an electronic health record (EHR) or PM system, the physician is able to select the correct codes while in the exam room and potential coding errors can be flagged before the claim is submitted.
Should you decide to choose an outside billing or RCM service, look for one that offers these primary features:
- Denial/rejection/appeals management
- Payment posting and monitoring
- Printing, mailing, and emailing patient statements
- Unpaid balance management
- Patient and insurance payment posting
- Fee schedules and contract maintenance
- Financial reporting
- Monthly consultations
- Support, training, and upgrades
- A billing dashboard and comprehensive reporting
- Compliance with HIPAA, OIG, and ICD-10 regulations
- Insurance payer management and fee schedule review
- A dedicated account manager leading a team of billing experts
- Use of scheduling, PM, and EHR software as part of the RCM package
- Easy options for patients to pay
If you can get a handle on the more common billing pain points you can be in a better position to evaluate the health of your practice. To learn more about how RCM can help your practice call 1.888.491.7900, or read our white paper , How to improve practice financials: A practical guide to revenue cycle management.