It seems one of the new buzz words in the electronic health care industry is revenue cycle management companies. So what has changed in the last 24 months to bring about this industry change? Working with so many physician practices I was able to get their take on this exact question. We all know that payments have and will continue to go down, so it is imperative to ensure physicians are getting paid according to their contracted fee schedule. This can be a daunting task when working with hundreds of payers each month. Keeping up with regulatory changes also wreaks havoc on a practice, it eats up a lot of the biller’s time to try and determine how new changes need to be implemented. Incorrectly implementing a change leads to denied claims and hours of re-working denials.
On the front end of the system revenue cycle teams that handle all services start work before the patient even arrives for their appointment. They are handling eligibility verification to ensure that the patient has valid insurance and the practice knows what co-pays or deductible payments should be collected at time of visit. This also helps alleviate denied claims due to lack of coverage or change in coverage. Additionally, on the patient side the RCM team will send out patient statements, I think we can all agree what a time consuming expensive process it is to print and mail patient statements each week. A full service company will even offer collection services; many practices find this beneficial as it takes collection focus off the practice when handled by a third party.
The biggest benefit was noted as having a system in place that on a daily basis verifies that claims are being sent accurately and processes claims within 24 hours. Rejections are worked on a daily basis no matter the dollar value. Many revenue cycle management companies have a dedicated account representative that provides reports and also holds weekly meetings as to the progress. Although many said they were concerned in the beginning that they would have to let staff go they found they were able to move them into other areas of the practice which increased patient satisfaction. The increased income from higher collections covered the cost of the services being a win for all involved. With all of the great benefits it is easy to see why this new phenomenon is growing daily. As with any new endeavor make sure you vet the company you are looking at. Make sure they have the experience needed to provide for all of your billing needs. It is nice to see an industry shift have such positive outcomes for physicians.