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!

Many small medical practices still do their billing in-house. The success or failure of your billing team can make or break your practice as a business. However, it can be one of the most difficult functions your staff performs. You might have a crack team of billing analysts who are also great at collections. Chances are, though, that you will get better results with a company that specializes in billing and collecting millions of dollars a month for various clients.

In this article, we talk about the difference between in-house and outsourced billing, discuss the pros and cons of each and give you a look at the cost and savings associated with an outsourced solution. If you aren’t ready to hand over 100% of your billing operations, you can start with a hybrid approach, such as seeking assistance with collections and simplifying your billing system.

Whatever you decide, OmniMD has solutions that can help your front desk and back-office crew minimize mistakes, improve efficiency and increase patient satisfaction.

In-House Vs Outsourced Billing Comparison

In-house medical billing typically consists of billing clerks entering medical codes into billing software that interfaces with insurance companies and other payers. It also involves handling various aspects, such as reporting, required to close the revenue cycle.

When you outsource your medical billing, you or your business manager engages with a third-party company that specializes in billing, collections and other aspects of the revenue cycle. Ideally, this gives physicians and staff members more time to focus on patients and day-to-day operations.

Let’s take a deeper dive into the pros and cons of both options to give you a clearer picture of which one would work for you.

In-House Medical Billing

Many physicians or other practitioners decide to keep their billing in the hands of their staff. You may feel more comfortable having oversight over revenue and collections, and that’s understandable.

You may not want to trust a third party with your patient information or the part of your business responsible for bringing in the money. However, there are pros and cons of using EHR billing software versus customized billing solutions from a third party. You might be surprised what you would find if you crunched the numbers, taking into account the total cost and savings of each option. Additionally, you should consider factors such as accurate billing and timely entry of payment requests.

You may feel you have effective billers who enter data and collect payments efficiently. Therefore, switching to an outsourced solution may seem counterintuitive. With in-house personnel, you can walk down the hallway to check on a billing issue. When you outsource this function, you have to contact the billing company,

However, there’s a price for this convenience. When you pay billing analysts and billing clerks directly, you also have numerous administrative costs that are lower or nonexistent when you go with an outsourced billing provider.

Many practices are still feeling the crunch of government regulations that resulted in lower reimbursements. If you want to save money, you can’t just cut salaries or hire less qualified people. However, if you transition to an outsourced billing company, you may realize significant cost savings.

In-house billers often lack the necessary support to perform at their highest level on every task. Additionally, small offices may only have one or two people doing the billing. If someone quits or gets sick, you’re going to see a major reduction in revenue until you are once again fully staffed.

Pros and Cons of In-house Billing

Pros

Maintain control
Proximity
No need to invest in a new system

Cons

Administrative burden
Higher staffing and support costs
Subject to turnover and other employee challenges

Outsourced Medical Billing

By outsourcing your medical billing, you access the bench strength of a large billing department. So, if you are a small practice, you don’t have to worry about decreased revenue due to an employee falling ill, going on vacation or seeking other employment. Instead, there’s always someone to fill in the gap to keep your revenue stream steady.

When you hand your billing over to a third party, you pay a small percentage of your collections. Therefore, the company only gets paid if they bring in revenue. This motivates outsourced billing providers to work with maximum efficiency. An outsourced billing team, such as that available at OmniMD, is also going to work harder to recover aged collections.

Many physicians spend as much as an entire day on paperwork. That’s a lose-lose situation. Every minute a health care provider isn’t with a patient costs your practice money. Additionally, most doctors aren’t trained in billing and administrative tasks nor do they find the work satisfying. This may put your office at further risk of missing payments or letting a superbill fall through the cracks.

On the downside, patients and staff members may find using a third-party billing company inconvenient. Since outsourced billing takes place off premises, it requires extra effort to monitor and provide the necessary information needed to establish effective billing practices. Therefore, it’s important to choose a vendor with great collaboration and communication skills.

Choose a company with proactive business practices and automated reporting and other functions. Choosing a company such as OmniMD gives you virtually endless opportunities to customize your billing software and enjoy a transparent relationship that improves your revenue collections, billing efficiency and staff and patient satisfaction.

When considering both options, outsource billing appears to have fewer shortcomings than hiring billing clerks and analysts on premises. Plus, having less oversight can be both a pro and a con for physicians who want to concentrate on the practice, not paperwork.

Outsourcing Pros and Con

Pros

Reduces billing errors and denied claims
Improves cash flow
Ensures billing compliance
Maximizes use of office space for medical business
Puts physician focus back on patient care
Reduces employee count and administrative responsibilities
Improves revenue cycle management
No-cost regulatory-compliance
Update your billing technology and simplify data entry

Cons

Give up some control
Not located on premises

Cost Savings Example With Outsourced Billing

Billing specialists can make six-figure salaries, while it costs around $4,000 or less for billing services. There are many other costs that you can reduce or eliminate by outsourcing the billing for your practice, including the following:

Billing Staff Salaries
Billing Software Cost
Hardware costs
Continued Education Training Cost (will be less when you outsource)
Ancillary Costs
(Office Space/Office Supplies, Patient Statements, Others)

Carrying collections in the form of bad debt is a reality for many practices. When you outsource your billing, you gain access to persistent collections specialists. While in-house collection efforts typically yield a 60% collection rate, that figure jumps to 68% when you partner with an effective medical billing provider.

Let’s say you have $2.5 million in uncollected debt. Your in-house collections team may recover $1.5 million, or 60% of the debt. Meanwhile, focused specialists at a third-party provider might collect $1.7 million, or 68% of bad debt that otherwise becomes a write-off.
Taking a Hybrid Approach

There may be sensitive accounts or services that you want to bill for directly. It’s perfectly acceptable and you can achieve the same boost in collections and savings while keeping a portion of the billing in-house. Find a company that will work with you to meet the needs of your practice.

Are You Shopping for Billing Solutions for a Billing Company?</h3/>

OmniMD also provides billing solutions for billing companies. If you want to implement intuitive, consistent forms for all of your medical billing clients, partner with our team for end-to-end medical billing services that allow your staff to manage all your customers with a single sign-on. OmniMD has your solution. We will integrate data from all of your legacy systems, including EHR, Practice Management, and Patient Portals.

Want to know why more physicians and practices choose OmniMD? Request a demo today!