What Is Revenue Cycle Management, and How Does It Benefit Health Organizations?

What Is Revenue Cycle Management, and How Does It Benefit Health Organizations?

by | Jul 25, 2022 | blog, Medical Billing Service

What Is Revenue Cycle Management, and How Does It Benefit Health Organizations?

July 25, 2022

Revenue Cycle Management
Health organizations may seem to generate positive revenues based on paper records but how much of it is actually realized and the speed of cash inflow tells the story of its financial health. Revenue collection can be negatively impacted by poor coding, errors in billing and delays or denials by insurance companies. Most of these and other deficiencies can be overcome and addressed by the use of revenue cycle management solution.

What is revenue cycle management?

Revenue cycle management (RCM) is a process, usually a part of EMR or EHR systems used by healthcare services. It is comprehensive in nature, ranging from scheduling appointments to registrations to giving a cost estimate to tracking a patient’s treatment to billing, recovery and follow up.

With covid-19 pandemic hitting the healthcare systems on a global level, about 75% of healthcare facilities implemented RCM to continue serving the patients despite quarantine and social distancing measures.

RCM software delivers proven benefits not only to patients but to the healthcare service providers as enumerated in the following paragraphs.

The revenue pitfalls in healthcare services

Healthcare organizations need a steady and healthy cash flow in order to meet expenses as also for future expansions. However recovery of dues is not 100% guaranteed due to various factors:

  • Not collection complete information from the patient as regards health condition and insurance coverage,
  • Disputes arising due to misunderstanding about patient’s expectations of cost of treatment and actual treatment,
  • Delays and denials by insurance companies in settlement of claims, and
  • Changing laws and regulations.

The RCM System addresses these and other issues and when incorporated as part of medical appointment software or plugged into EMR/EHR, can considerably reduce outstanding and improve transparency, reputation of the healthcare provider and also give satisfaction to patients.

RCM enables streamlined collection of data

Healthcare service providers may choose to outsource this work to a revenue cycle management company but it makes good sense to have this process in-house. With revenue cycle management integrated into existing software solutions such service providers can streamline processes such as:

  • Schedule an appoint
  • Register a patient
  • Collect patient data such as health and medical records and vital insurance papers and check about claims admissibility

It is vital for healthcare providers to collect patient’s medical records in order to know the line of treatment to be initiated and costs involved and to also know just how much of these costs can be covered by insurance and how much the patients will have to bear. It is wise to give patients a clear indication of their part of financial burden rather than spring surprises later on after the treatment is over.

Revenue cycle management can use this data and the RCM software to:

  • Record treatments and associated costs
  • Raise bills and submit claims to the insurance provider using the right codes to record them so as to avoid denials
  • Follow up for recovery of dues, send reminders and collect payment from patients and also from insurance and to refile claims in case of denials. If insurance is denied outright then amounts may be recovered from patients through the automated software. Insurance can be a very sticky point and errors here can lead to misunderstanding with patients and also loss of revenue by way of denied claims. Automation, fine tuning and reminders in the RCM greatly improve the insurance part of the process.

Considering that not all healthcare providers are the same in the method of operation or size, they may need custom RCM systems in the selection of which suitable revenue cycle management consultants can be of great help. They can assist in selection of the RCM software and also to set up best practices for revenue cycle management.

Benefits of Revenue Cycle Management Solutions to Healthcare Providers

Engage revenue cycle management consultants to choose the right revenue cycle management solution and have them set up the RCM system to suit your particular method of operations. You may need to have the RCM software integrated into the medical appointment software, which the software provider can carry out. The first step is creating awareness about the importance of fast cash flow and encouraging use of the software by personnel who must be given training in the use of RCM solutions.

This leads to systematic benefits as given below.

Streamlining

RCM streamlines the connection between health records, treatments and accounting system through integration. You have single point view of the financial health, billing, bad debts, receivables and claims (in process, disputed, and denied).

Better, faster and higher recovery

Recovery from insurance is a sore point and by reducing errors of coding and filing claims under the right head, the software improves recovery rate and reduces percentage of denied claims while also issuing alerts about refiling within the stipulated time, thanks to efficient revenue cycle management systems.

Simplify tasks, automate them and reduce workload

The RCM solution simplifies tasks, reduces work loads, reduces margins of errors and provides a single window access to all records and facility for follow up for recovery. The RCM software reduces burden, time and efforts.

Single point access to all patient records

You have all patient records and related financial records in one place giving all vital information at a glance.

Fingertip analysis and generation of reports

Streamlined and integrated data can be analyzed quickly to derive insights about revenue flows and state of financial health of service providers, thereby enabling timely action. Knowing your financial condition can help you to take corrective action to reduce debt and speed up cash flow.

Create a better impression, improve relationships and generate more business through referrals

By being open, transparent, honest and upfront about treatments costs the healthcare provider creates a better impression in the minds of the patients, leading to more referrals and recommendations.

Healthcare is infinitely more convoluted and complex than cash and carry businesses. Healthcare is a business in a manner of speaking, relying on healthy revenues for sustenance and growth. The right revenue cycle management solution makes a world of difference to financial health of providers as well as patient relationships.  It is advisable for healthcare providers to choose RCM software with care and also have it implemented by RCM consultants/solution providers in order to make the best use of it.

 

 

Let the RCM software improve healthcare services through real-time data management, accurate records, and reduced fallacies. Opt for RCM software now!

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How do you choose the best medical billing company?

How do you choose the best medical billing company?

by | Jul 21, 2022 | blog, Medical Billing Service, Medical Billing Software

How do you choose the best medical billing company?

July 21, 2022

Next-gen Electronic Health Record
The medical IT industry has revolutionized in the last few years, especially since 2019. IN 2020, when the pandemic affected the world, this has bridged the gap between technology, administration, and resources. There had been a significant breakthrough, shifting from manual administration techniques to electronic health records. This would include everything from communication protocols to lab reports and from efficient medical billing systems to managing the healthcare system. In particular, this has changed the tasks of medical billing specialists considerably with the help of technology.

The billing in healthcare is very enduring for both payers and their payees. However, with the help of the best medical billing software on the market, you can use appropriate and updated medical billing strategies. While choosing the best medical billing and coding software will help the providers and practitioners simplify the billing process, resulting in increased revenue and efficiency.

Additionally, a switch to efficient medical billing software would reduce the costs of human efforts and aid in embracing electronic technologies in this sector. Instead, the providers and practitioners can generate invoices from one single interface while reducing the amount of paperwork simultaneously.

So, if you choose the best medical billing company for your practice and providers, let us assist you with the __-step guide to choosing the best medical billing company for your practice.

Determine Your Needs

When searching for your healthcare billing software, the first and foremost thing is understanding your needs. Different sizes have different requirements, and additional requirements mean additional services. Some might specialize in handling large practices, while others may have lower budgets and few physicians to operate.

While determining your size, the parameters to keep in mind are: practice budget, provider size, and accepted insurance partnerships. These parameters will decide the type of healthcare billing software that is required.

Small-scale billing services

For smaller practices, the small-scale medical billing services are perfect! They have a smaller budget and data volume, along with fewer physicians. This will provide more personalized, highly reliable, one-on-one service. This is also cost-effective and will allow your practice to save good for billing.

Physician practice Management Company

The majority of the practices require this type of size. These are the ones who will provide services to around 200 or more staff members. They are well-equipped with their expertise in the medical and coding field and handle high data volumes. They can also manage the administrative and back-office tasks.

This might get pricey sometimes, as they can charge some extra pennies for the billing and coding services. Inquire about their charge and different services, which will let everyone stay on the same page.

Professional Billing company

A large medical company will contribute extra and valuable additions to your practice. This will allow you to focus on your core tasks, i.e., patient care. These organizations will cost you more and be a little pricey for your medical billing and coding needs. However, ensure about the available plans, included features, and the additional costs.

Search for Experience

Certain medical billing companies have specific focus areas but are experts in those areas. While others might have specialty areas, they can work with various practices. The first thing to ensure while hiring the best medical billing company is EXPERIENCE. This is important because the primary cause of claim denials and revenue loss is incorrect billing and coding. This is why the practices prefer to collaborate with the top experts in the field with undivided attention and error reduction. So decide on your priorities and act accordingly.

Inquire for the cost breakup

While outsourcing essential billing services, you must not forget the cash factor! It would help if you diligently calculated the cost for each service being availed and provided. There are various ways to charge as per a medical billing company. Some might charge a percentage of the net generated revenue, others charge a flat fee irrespective of the generated income, and others go for both.

So decide how to be billed for the services and then narrow down the companies. Read line-by-line while comparing the quotations from various suppliers. Also, remember! Cost is never proportionate with quality. Have a thought!

Compliant

Healthcare practices always need to abide by compliance rules and regulations strictly. It is imperative and crucial for the companies to follow these compliances. So before selecting the hospital billing software for your practice, ensure that they follow these rules and protocols perfectly.

Company Reviews Matter

A good company will have a good reputation as well. So when you sit down to negotiate, ensure that you have complete background knowledge of the same in the market. After all, Word of Mouth is the best publicity. You can also refer to the online reviews and responses that will allow you to review appropriately.

  • Ask them a few questions so that they can be appropriately relied upon for your medical billing requirements.
  • Did your last three clients provide positive responses?
  • How to handle the revenue loss and claim denials due to erroneous data and details?

Ask for the testimonials, references, reviews, and responses that the client has from past clients. Remember! It is crucial to be the best medical software for revenue generation and claim success.

Check Browser and Software Compatibility

Using the internal software for patient accounts and other financial tasks can hamper the usability and effectiveness of the billing software. This is why you need to search for the software and provider which will be compatible with the internal software’s key features. This would require new software to incur additional expenses. Additionally, knowing about the software will let your staff align with the user interface and workflows.

While the decision of choosing the best medical billing company is enduring and challenging at the same, stay well-informed of the company’s history in this sector. If the company has a history of claim denials and rejections, this is a clear signal of not being a good billing software. Try everyone before making the final decision.

Still, in case you feel more discussions to be done, ping us, and we are readily available for your assistance.

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Practice Management Vs. Medical Billing Software – What is Right for You?

Practice Management Vs. Medical Billing Software – What is Right for You?

by | Jul 18, 2022 | blog, Medical Billing Service, Medical Billing Software, Practice Management

Practice Management Vs. Medical Billing Software – What is Right for You?

July 18, 2022

Medical Billing Software
As every healthcare practice has its own needs and goals, so is its requirement. Some want efficiency to improve; some want to streamline their claims processing to be hassle-free. At the same time, others might be more interested in notifying their patients of upcoming appointments and bill the same timely. Some might want a combination of these, and some might look for all of them.

It is fine to approach your life in whatever way you want to, but when it comes to purchasing Medical Billing System or Practice Management Software, remember that you are responsible for others’ lives and health simultaneously. This is why understanding the significant disparities between the nuances of medical billing software and medical practice management software is very important.  

But the one major area that is confusing for all is the debate on medical billing software vs practice management software. These two might look similar to a layman, but they are way apart regarding workflow. So, this article will focus on the significant disparities in the working of the Medical billing system and the processes involved in Practice Management Applications. 

But before stating the differences, let us understand the basic functionalities of both and then we will see the advantages of Practice management billing software. 

What is Practise Management Software?

The Practise Management Software is the application so designed to assist the medical offices in the running effectively and efficiently. In general, the small and medium-sized provider system can manage daily operations like financial processes and administrative functions, while some organizations can utilize it for electronic medical records.  

The standard capabilities of any practice management software can include the following but are not limited to: 

  • Patient registration 
  • Patient tracking
  • Patient appointment and its scheduling 
  • Tracking charge capture 
  • Performing the billing procedures and claim processing 
  • Payment processing from patients, insurance providers and third-party providers 
  • Generating staff reports 

 As PMS simplifies patient data management, the adoption of these systems has grown drastically over the last few years. According to Grand View Research, the US$12.9 billion market size value of PMS in 2019 is expected to witness an annual growth of 8.8% by 2022 to 2030. 

There are three different ways to install the software: desktop-only, client-server, and Internet-based. 

 Desktop-only software: This can be used on a single computer by the few who can access the system. 

  • Client-server software: This can be accessed by multiple users with data sharing and on-site server access that the practice has to purchase or lease. 
  • Internet-based software: The user can access the internet and eliminate the server purchase pre-requisite, but this can hamper the security as patient data is accessible externally. 

 The Practice Management Applicationsalso manages big data like ICD codes and procedures, third-party insurance providers, medical procedures, and providers.  

Pros of Practice Management Software

The software is responsible for helping various departments in any practice as mentioned under:  

Front Desk Staff 

The Front Desk Staff will not duplicate the insurance card. Instead, the staff will scan the card to capture the relevant information. This will save time and human efforts at the same time. 

Billing Department 

The billing staff can submit and re-submit the insurance claims quickly as that software automates the tasks. This would save time and boost cash flow efficiently. 

Physicians 

The physicians can validate the ICD codes for the patient diagnosis and with the insurance company before ordering the same. Additionally, this software can ease the other administrative functions required while running a practice. This will allow the practitioners to continue their practice at ease without bothering about their different roles.  

What is Medical Billing Software?

The Medical Billing Software will handle all the tasks from where the patient appointment is scheduled until the time the patient finishes the telehealth session with the practitioner. Medical billing services are an essential feature in medical practices, which is vital to obtain when the patient appointment is set up, insurance is claimed, claims need to be re-submitted, and more.

This is why the practices with in-house medical billing specialists also prefer to use their medical billing services.

 Ever been caught in a situation like when to send the bill, when the second or third notices are sent for missed payment reminders, or view the generated billing reports all at once? The medical billing services will come to your aid. 

Major Disparities in the PMS and Billing Software

The primary difference between practice management software and billing software is that the PMS is responsible for managing the administrative side of the practice, and the billing software takes care of the clinical element of the practice. The PMS maintains the facility management records in digital format and is not shared externally. On the contrary, the medical billing specialists need to share the individual patient data and records with other medical professionals and practitioners.

So which are the tasks that you need to handle with software? Most providers and practitioners use the software for administrative and clinical uses. This is why the decision to use the software must be decided based on compatibility. This will help the software end-users ensure that the departments are working in sync and data consistency is maintained.  

Numerous vendors in the market offer Practice management billing software: an easy and seamless integrated software. Try one of these software as per administrative or clinical requirements. At times, these integrations reduce the human efforts, which in turn enhances the provider’s performance and management at par with the competition.  

In Other Words 

It is not uncommon to summarize the medical billing software with practice management software. The billing software and system handle the creation and maintenance of the healthcare services provider. The PMS focuses on the revenue flow and patient support features like scheduling, patient charting, medical records, and more. 

Medical practices of all sizes find it appropriate to use practice management software that helps billing specialists manage and maintain their growing and ongoing practice. Additionally, this software is ICD-10 compliant, which is why they are more reliable and secure. 

Still, confused about the software to choose for your practice? Schedule an appointment with us, and we will assist you hereon!

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EMR Vs EHR – What Are the Essential Differences between EMR and EHR

EMR Vs EHR – What Are the Essential Differences between EMR and EHR

by | Jun 27, 2022 | blog, EHR, EMR

EMR Vs EHR – What Are the Essential Differences between EMR and EHR

June 27, 2022

EMR vs EHR
To the layman there is a certain amount of equivalence when one talks about medicine and health. Apparently the two go together and are interconnected which is true to a certain degree but there is a fine distinction when it comes to records, especially those maintained in electronic form, usually in the form of software based EHR systems. This is the current trend and data is stored as Electronic Medical Record (EMR) or Electronic Health Record (EHR), the terms sometimes overlapping and used interchangeably. It must be noted that over 93% of hospitals in the USA use EHRs. A closer look shows that these two are disparate as we will differentiate in the ensuing paragraphs. People do tend to conflate EHR and EMR.

Some common functions of EMR:

  • Keep individual track of patients
  • Identify which patients are due for a consultation/checkup/screening and send out notifications
  • Keep track of patient’s specific health condition and progress as well as response to treatment
  • Diagnostic record
  • Financial aspects

What is an Electronic Medical Record (EMR)?

One way to look at an electronic medical record is to consider it as a subset of the electronic health record. The EMR is usually maintained in electronic medical record systems software supplied by a known vendor. The EMR contains data about a specific patient as regards health, demographics, diagnostics, treatments and finance, sometimes in relation to a particular health condition or illness. It is almost always created by clinical or non-clinical staff within a medical practice and it is not transferable electronically due to legal constraints. If at all a patent switches to another medical practitioner who requires access to the electronic medical records then the previous clinician would probably print and send a paper record.

What is an Electronic Health Record (EHR)?

The chief and identifying characteristic of the electronic health record is that it is created by an enterprise health system and it is shared between healthcare organizations. It is also more wide-ranging in scope, covering not just specific ailment, diagnostics and treatment but also including an overall picture of the person’s general health conditions and physical characteristics. It also includes data about the patients’ treatments at various other healthcare facilities and clinics, covering their history. It paints a larger picture of the patients’ medical journey. Larger healthcare services providers make use of more sophisticated and secure EHR system to manage patients’ electronic health records. Access to the EHR of patients help larger healthcare services to know about their past and arrive at a faster treatment solution instead of having to start diagnostics from scratch. It also saves money and time for both patients and services.

Provided large healthcare services provider obtain their electronic health record system set up by specialist IT vendors there are quite a few benefits:

  • Ability to deliver specialized, higher level specialized care to referred patients
  • Save lives by acting fast based on availability of complete medical records
  • Let patients view their own records and thus encourage and motivate them to take better care
  • Avoid duplication and redundancy by way of lab tests and diagnostics and save time, effort and money
  • Provide better follow up care and holistic improvements to patients

 

Key differences between EMR and EHR:

The above explanations of EMR and EHR show why it is easy to conflate the two together. However, the following fine distinctions should make the differences pointedly clear.

Accessibility

As stated above the EMR is created by a particular doctor or medical facility and such records are treated as confidential. The patient or another healthcare service provider does not have direct access to the EMR.

Electronic health records, maintained in electronic health records software by larger institutions are accessible to patients who can download softcopies. EHR systems are designed to be interoperable between institutions and data is standardized using standards such as Health Level 7 (HL7) that creates standardized formats.

Interoperability

EMR systems used by small medical practitioners may be custom built by vendors and store data in their specifically created formats that may not be directly accessible by EHRs. It is a closed system. Electronic Health Records software is designed to be interoperable between different institutions across the country or the world with standardized formats and data systems as regards documentation, medicine management, diagnostics, clinical decisions, reporting, financials and analytics.

It must also be kept in mind that insurance also comes into play and interoperability provides convenience in this regard.

Higher security in EHRs

EHRs by their very nature are used in large public health services and the fact that data is shareable and systems are interoperable imposes a higher level of security and safety standards to prevent such data falling into the wrong hands or being hacked. As such, larger healthcare services must pay special attention and care to choosing electronic health records software and also on the vendor’s capability to provide ironclad security for storage and also for transmission across the internet.

Which one to opt for? EHR or EMR?

The foregoing paragraphs clearly delineate the vital distinctions between EHR and EMR. The question is which one should you choose as a medical service provider?

Individual practitioners and small clinics will find it easier, convenient and affordable to go in for compact and easy to use electronic medical records software that can be installed and managed in-house. Such practitioners can access patient’s EMR on their office systems as well as through their mobiles. However, it must be kept in mind that there will be quite a few patients whose condition, treatment required and the lack of facilities in the individual doctor’s clinic will make it necessary for such patients to be referred to larger hospitals with better facilities. As such, the right recommendation is that individual practitioners will find it a wise choice to go with electronic health record software right from the start due to interoperability, higher security and access.  If this is the choice, and it is the right one at that, what remains to be done is to choose the right vendor and get a cloud based EHR software solution that includes messaging, financials and billing in one package.

 

 

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Benefits of Medical Billing Services for Small Businesses

Benefits of Medical Billing Services for Small Businesses

by | Mar 31, 2022 | Medical Billing Service

Benefits of Medical Billing Services for Small Businesses

March 31, 2022

Benefits of Medical Billing Services for Small Businesses
Health care providers today often struggle with the administrative side of things. After all, health care providers are trained to help people overcome illness and get back to being healthy — not for dealing with accountancy issues and chasing money. 

Whether you’re running a small practice between 1-5 physicians or are a bigger practice capable of treating a large number of patients, medical billing outsourcing services are probably of interest for your practice. 

Patients don’t always have the resources to pay for their consultations and treatments upfront and often require billing at a later stage. 73% of health care providers report that it takes longer than one month to collect payment from their insurance and even more from the patients. 

The growing need for external medical billing services is reflected by the pace at which the market has grown over the last several years. Statistics show that the worldwide medical billing outsourcing market was worth USD 10.2 billion in 2020. The market is predicted to increase at a compound annual growth rate (CAGR) of 12.66% between 2021 and 2028. 

What are Medical Billing Services? 

Medical billing services are outsourced third party companies that take care of accountancy and debt collection requirements for health care providers. Typically, they work alongside practices to implement a system to track and chase payments from insurance and patients. The process often involves the use of medical billing software which streamlines the operation. 

How Does it Work? 

Most medical billing services these days operate on cloud-based platforms or medical billing software. This digital advancement diminishes the need to install or set up any complicated system. It’s designed to streamline your working process and to help your practice save the time and energy spent on chasing up bills. 

Benefits of Outsourced Medical Billing Services for Small Practices 

Outsourcing medical billing services for small practices are less of a “good idea” and more of an immediate necessity. Without them, your practice’s working process can experience heavy disruptions. 

Not having a medical billing service set up can also lead to significant cash flow problems which threaten the good standing of your practice. Let’s take a look at some of the benefits of outsourced medical billing services. 

Less Stress 

When your patients don’t pay their bills, it results in cashflow mishaps, making it more difficult for your practice to pay the bills and operating costs. Having this constant threat looming in the background causes stress to everyone involved in making sure the practice is running smoothly. 

Choosing outsourced medical billing services and getting started with medical billing software can eliminate this issue. 

Improved Workflow 

When you opt to outsource your medical billing services to a trusted third party, you immediately relieve a practical and psychological load. Without having to worry about chasing up unpaid bills, your practice will notice an improvement in workflow and productivity and obviously focus better on treating patients. 

Saving Time 

Typically, individuals who get into healthcare don’t do it because they love administration and chasing patients for money. They do it because they like to help other people manage their health. 

However, unless your bill collection requirements are being met by someone else, you’ll end up spending more time chasing down bills than actually practicing. 

If your practice caters to several hundred patients in a month and each of them needs to be contacted and chased for payment, it’s easy to see how that could become extraordinarily time-consuming. It would almost be worth hiring another full-time employee to take care of it. But is that really the best option? 

Saving Money 

While hiring another employee solely for the purpose of collecting payment may sound like a good idea at first. However, you should also consider the extra cost in terms of paying for paid holidays, employee healthcare, training costs to keep up with ever-changing guidelines, and employee benefits. 

Choosing outsourced medical billing services allows you to bypass all of these extra costs while also catering to possible variability. For example, it might not take always take full-time hours to get the job done, and it may vary from week to week. Medical billing and coding services from a third party are a great solution for getting the job done in the most efficient manner possible. 

Bill Compliance 

Non-compliance to bill payments is one of the largest threats to small medical practices. Choosing to delegate your bill collection to a trusted partner is a strategic and highly recommended move. It eliminates the threat of patient non-compliance to bills and helps practices get paid on time. 

Patient Satisfaction 

Not only do outsourced medical billing services help you and your practice run smoothly, but they also improved patient experience and satisfaction. Medical billing and coding services offer more streamlined ways to pay bills which contributes to the overall patient experience. 

Increased Revenue 

Having debt collection taken care of by a third party will increase your work productivity and improve your practice’s cash flow. All of the benefits mentioned above result in an overall increase in company revenue. 

Streamlined System 

You shouldn’t have to go through a demanding training session to understand the system and maximize your medical billing services. Instead, you can expect your system to be up and running in less than a day, and your personnel to be completely comfortable using it after only a few hours of training. 

The Bottom Line 

Poorly organized bill collection systems are one of the greatest threats to small medical practices. Luckily, you can outsource your medical billing needs to a third party who will take care of everything so you can do the work you love. 

Choosing outsourced medical billing services has many advantages, including saving on time and costs, increasing revenue by increasing bill compliance and improving efficiency, and reducing workplace stress. 

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