8 Revenue Cycle Management Services That You Cannot Ignore

 The most important technology that any healthcare practice can use is electronic health record (EHR) software and revenue cycle management (RCM) services. These solutions help modernize practices, make the patient and practitioner experience more streamlined and joyful, and increase revenue and cash flow. EHR software has the opportunity to boost efficiency and profitability while also improving patient outcomes.

 

There is plenty of neglected extra front- and back-office activities that can help you grow your firm. Credentialing, benefits verification, patient call center, worker compensation, out-of-network billing, prior authorization, information release, and contract/payer negotiations are just a few of the services available.

 

While these activities are critical, providing in-house assistance is sometimes too expensive and time-consuming. That doesn't mean that our goals are out of reach. Here's how auxiliary services from industry-leading healthcare IT firms may help you grow your business.

 

Prior Authorization:

 

Obtaining prior authorization, like many other administrative responsibilities in healthcare, is crucial. However, the administrative process surrounding prior authorization can be time-consuming and costly, clogging up administrative workflows. Front-office workers frequently believe obtaining previous authorization is straightforward. If you know your patient's insurance policy, obtaining treatment coverage from the payer should be rather simple. Right? 

 

The short answer is No, it isn't always the case.

Increased denials could result from a lack of understanding or a limited time constraint within your billing department, which could have been handled at the previous permission level. That is why certain healthcare IT service providers give complete prior authorization support to assist you in obtaining prior authorization the first time.

 

Credentialing:

 

Credentialing is the process of ensuring that doctors have the training and experience they need to practice medicine safely, efficiently, and effectively. This highly important and mandatory step can be quite time-consuming, so it is so commonly skipped.

 

Credentialing solutions, such as the Council for Affordable Quality Care (CAQH) quarterly re-attestations, are meant to help your physicians retain their credentials with both government and commercial payers.

 

You may assure that the credentialing process for the provider continues persistent by outsourcing it. Shifting the stress and burden of maintaining provider credentials allows you to focus on more critical growth strategies like increasing operations, lowering managerial constraints, and retaining and attracting new patients.

 

Benefits Verification:

 

Checking a patient's eligibility is one of the first steps in the medical billing process, and it's also one of the most common stumbling blocks in the patient-provider relationship.

 

To prevent problems and improve the patient experience, companies like MediFusion seek to reduce administrative burdens, eliminate errors and denials, and improve the entire patient experience. Patients are more likely to be high-rated, returning patients if treated fast and effectively with complete expense transparency.

 

Investing in a service provider who can handle all aspects of medical billing not only saves time and money but also improves patient satisfaction because eligibility checks are quick and easy.

 

 

Worker’s Compensation:

 

Due to the specialized terminologies, collection procedures, and numerous legal impediments, workers' compensation collections can be extremely complex for providers to manage. Workers' compensation is highly specialized and does not adhere to a single set of rules, as each state in the United States has its own set of laws and regulations. Any billing department will have a lot of hassles as a result of this.

 

Workers' compensation accounts for up to 5% of a hospital's accounts receivable; thus healthcare providers rarely spend additional dollars to engage a workers' compensation expert, even though it is extremely difficult to handle. Instead, rely on service providers to help you submit workers' compensation claims to specific payers.

 

Patient Help Desk:

 

Similarly, collaborating with a service provider that provides an inbound patient call center for your clinic will relieve some of the pressure from your administrative team, especially when it comes to intricate billing issues. This reduces overhead costs and provides you with the staffing flexibility you need to expand your practice.

 

Even better, patient call centers can collect payments from patients on your behalf, saving your employees time chasing down outstanding bills.

 

Patient call centers give devoted professionals to practices like yours who are solely responsible for answering billing questions, collecting payments, and resolving defaulted accounts. This can allow your company to expand, decrease internal inefficiencies, and improve patient and employee satisfaction.

 

Out-Of-Network Billing:

 

Out-of-network billing can generate a significant revenue stream for your practice because you are not constrained by the terms and conditions of a payer contract and can bill as much – or as little – as you like. However, not having experts on hand can cause payments to be delayed.

Everything is managed externally with a service provider like MediFusion, from sending claims and posting payments to negotiating the payment from the payer and working with the payer to paying the negotiated amount. This allows you to devote even more time and resources to improving patient outcomes. When it comes to out-of-network billing, it's a no-brainer to hire a team of professionals that can help you optimize your profits.

 

Release of Information:

 

To comply with state and federal standards, hospitals and health systems are already fighting an uphill struggle to manage release-of-information (ROI), which includes keeping up with the increased number of record requests from attorneys, auditors, and payers. Many healthcare institutions are finding it increasingly difficult to manage this very complex and regulated process independently.

 

 

Transferring complex ROI activities to a team of professionals will free up precious resources and protect your team from legal hazards. By removing the administrative weight from your shoulders, MediFusion helps to streamline the ROI workflow.

 

Payer Contract Negotiations:

 

Negotiating payer contracts may be the most tiresome and time-consuming aspect of establishing healthcare practice out of all the things you have to do. The agreements – or lack thereof – you have with payers could determine a big part of your clinic's success or failure.

The basic truth is that there is frequently more opportunity for bargaining than payers admit. Don't panic if you weren't aware of this; many physicians are in the same boat. The headache of managing payer relationships and negotiating contracts can be fully removed when you work with a firm like MediFusion. MediFusion, for example, will examine existing payer contracts, provide pricing and reimbursement recommendations, and follow the negotiating process from start to finish.

 

Even at the micro-level, getting the right RCM support is crucial to optimizing your growing practice. However, be wary of healthcare technology providers who exploit extra services, such as those listed above, to persuade you to change your EHR. You should be able to maintain your EHR if you're content with it. MediFusion integrates with your existing software, not against it. That is why it is critical to select a reliable, capable healthcare technology supplier who will not compel you to go through a time-consuming EHR transition when what you truly need are extra RCM services to help you maximize your profits and develop your company.

 

Summary:

 

While an EHR system is one of the most significant IT expenditures your company will make, it should not overshadow areas where little changes and workflow tweaks can optimize administrative procedures. Utilize the services of committed industry professionals who have been trained to handle the time-consuming, money-losing chores that are causing your company to lose money.

 

Remember that your healthcare IT partner should offer solutions that are adaptable, scalable, and work with rather than against your workflow. You should choose the investments that your company needs the most.