Medical billing and coding processes are becoming increasingly complex as the healthcare industry prepares for the transition to the ICD-10 coding system and Medicare and Medicaid continue to cut reimbursement rates. Medical professionals must be more specific when coding diagnoses and procedures, as well as satisfy a laundry list of requirements to ensure claims are filed correctly and in time for a quick turnaround. With new demands mounting and reduced revenue streams placing greater pressure on the bottom line, medical groups are looking to technology resources to increase efficiency and eliminate costly errors.
Unfortunately, many healthcare organizations do not have sufficient revenue cycle management technology to ensure all medical billing and coding procedures are completed properly to ensure a strong reimbursement rate and protect the bottom line. Uncertainty regarding the efficacy of an office’s technology is a prevalent concern in the healthcare industry, particularly when decision makers prepare for reduced revenue streams and new coding requirements.
To optimize available resources, physicians should consider teaming up with practice management experts who understand the benefits of revenue cycle management technology and how to generate results for increased financial stability in the short and long term.
Industry Chatter
Black Book recently conducted the first of eight revenue cycle management studies that revealed 72 percent of physician practices anticipate declines in profits as a result of underperforming or underutilized billing technology. Furthermore, 88 percent of business managers argue their revenue cycle management technology is antiquated, which may leave the business more vulnerable to a takeover by a larger provider group. The study found:
- 86 percent of office managers believe their current revenue cycle management technology cannot accommodate increasing regulatory requirements or updates
- 100 percent of office managers do not think their financial software is compatible with accountable care organizations
- 87 percent of practices want to upgrade their billing and collections systems
- 98 percent of independent physicians attribute short-sighted IT investments to the devaluation of a practice
- 71 percent of physician practices are considering investing in a combination of software and outsourcing services to enhance revenue cycle management systems
- 89 percent of organizations would prefer to get their software and consulting options from a single source
When selecting a revenue cycle management resource, the input and expertise of practice management specialists can prove to be invaluable. Not only will the industry professionals understand how to leverage the technology for optimized results, but they will be able to identify the key problems within an organization’s processes that must be addressed by the solutions. Leaving office staff and physicians to make these determinations on their own may result in a guessing game. Practices should know for certain what the current inefficiencies are and the best practices and solutions to overcome these barriers to profitability.
Pick Up The Pace
Practice management professionals can share their insider tips with healthcare providers that have proven successful in the past to optimize revenue cycle management technology, improve collections processes and strengthen the bottom line. By implementing best practices into daily routines, healthcare organizations can quickly realize proper use of technology can significantly accelerate the turnaround time and success rate of claims.
The speed at which claims are processed is important to both payors and providers. Adopting the appropriate software and applications to streamline billing and coding operations will boost efficiency and allow payors to respond faster. Many revenue cycle management solutions offer physicians the ability to submit claims via web services to cut down on paperwork and time.
Investing in the appropriate software and services can help practices avoid the most common causes of medical claims denials:
- Duplicate claims
- Insufficient information
- Expiration of eligibility
- Claim not covered by insurer
- Past the payor’s time limit
When these prevalent pitfalls are avoided and prevented, practices demonstrate more control over revenue cycles and enjoy the luxury of a consistent collections process.
In addition, it is key for practices to stay educated on the new standards in medical coding. When physicians and staff understand the latest requirements for coding claims, and specifying each procedure and diagnosis properly, payors will have no lingering questions when receiving a claim. Thus, practice management specialists with expertise in coding and billing can play a significant role in turning a time-consuming collections process into a smooth running operation.
