RCM360
A/R Services and Solutions
Struggling with attracting and retaining A/R and billing support staff? Seeking temporary or partial Healthcare A/R Support Services? Have a specific areas of revenue cycle management that require experts to supplement your existing team?
Turn to RCM360’s financial experts to help increase cash flow, manage A/R, and resolve claims.
Increase Cash Flow
RCM360 has helped healthcare organizations resolve even the most challenging cash flow situations – in some cases, even doubling a provider organization’s receipts within the first month.
RCM360 addresses this situation with a thorough process to identify the reasons your practice’s cash flow may be experiencing challenges, and determines the appropriate course of action based on those primary causes.
Primary causes of cash flow challenges:
Cause #1
Under Coding
- We’ve found a number of facilities performing services for which a higher code (higher fee) applies, but staff are coding these services at a lower rate. This means you’re performing the work but not being appropriately paid.
- The RCM360 team will perform an audit to identify where these gaps exist.
- We’ll then develop a plan and recommendations for your coding processes moving forward. An RCM360 Certified Coder will be involved in the process to help develop a plan and workflow, including a system for capturing the required documentation for the services.
- RCM360 will implement ongoing monitoring and reporting to ensure proper codes and documentation are being captured. This helps you get paid for the level of service you’re providing patients, and have the documentation required to address any questions that may arise.
Cause #2
High Denial Rate
- The RCM360 team will perform a thorough assessment of the denials, identifying the top, most commonly denied codes in your practice and determining why they’re being denied. It could be a case of incorrect documentation, or an incorrect code that’s being entered into the system.
- RCM360 will call each payer on rejected claims to ensure the rejection is legitimate and proper and determine what must be done in order to get it paid.
- A plan will then be created to rectify the situation. This entails:
- Clear definition of codes
- Creation of processes by a certified coder
- Internal training on proper coding
- Ongoing monitoring of rejected claims
- Quick remedy for rejected claims moving forward with rejections addressed within two business days
Cause #3
Reduction in Patient Visit Volume
- Decrease in cash flow for a number of practices is directly caused by the simple fact that fewer patients are coming in for fewer visits, yet this may not be immediately apparent to the practice, or may be a slow trend over time.
- RCM360 will establish trending reports to help you manage this piece of your business.
- We’ll review these with you on a regular basis so that you’re able to identify any decreases quickly and take the action needed to remedy the situation.
Cause #4
Claims Aren’t Being Submitted
- If your cash flow is suffering, a primary root cause may be that you have a backlog of claims that haven’t been submitted – and you may not even know these claims exist.
- RCM360 will identify these claims, and determine the root cause, which may be training issues, workflow inconsistencies, or lack of capacity within the practice to manage the claims properly.
- Next, we’ll develop a course of action which includes the implementation of a review process to catch any workflow issues your practice may be experiencing, and streamline the process to help ensure on-time submission.
- Ongoing monitoring will be established, and review processes will be implemented to identify and rectify workflow issues more quickly.
Manage A/R
Are your outstanding invoices getting older? Perhaps you’ve sent statements, tried to collect, or even resolve issues with your claims. Or, if you’re like many healthcare organizations, you may simply not have the time or expertise to deal with receivables in a timely manner.
Turn to RCM360 to pinpoint the root cause of your medical facility’s increasing and aging A/R and rectify the situation.
Common causes for an increasing and aging A/R:
Cause #1
High Denial Rate
- If you’re getting a great deal of denials, chances are that you have coding errors that are the primary cause. Yet there may be other reasons as well, such as lack of documentation or patient eligibility issues. RCM360 will perform a denial audit to identify the top reasons your claims are being denied.
- RCM360 will call each payer on rejected claims to ensure the rejection is legitimate and proper and determine what must be done in order to get it paid.
- RCM360 will develop a plan to address the situation to help minimize denials moving forward and more quickly address any denials that may happen in the future. This plan consists of:
- Clear definition of codes
- Creation of processes by a certified coder
- Internal training on proper coding
- Ongoing monitoring of rejected claims
- Quick remedy for rejected claims moving forward with rejections addressed within two business days
Cause #2
Claims Not Submitted (at all), or Not Submitted in a Timely Manner
- In many cases, the RCM360 team has found that increasing, aging AR is a result of non-submission, or late submission of claims.
- The first step is to identify these claims, and determine the root cause, which may be training issues, workflow inconsistencies, or lack of capacity within the practice to manage the claims properly.
- Next, we’ll develop a course of action to correct the claims and pursue payment (or official rejection for write-off).
- A plan will then be created to streamline the process to help ensure on-time submission, as well as to streamline claim correction and resubmission.
- Ongoing monitoring will be established, and review processes will be implemented to identify and rectify workflow issues more quickly.
Cause #3
Patient Collections
- Once we’ve identified patients who owe your practice money, the first step in managing the collections is to notify the patient that they owe a balance. Many practices don’t send statements on a regular basis, or their timeline between statements is rather long, which extends the collections process.
- Once the initial statement is sent, the patient will then receive a statement every 30 days so the balance owed stays top-of-mind for them. Weekly reports are also run to keep you informed of your patient collections situation.
- RCM360 will also implement services within your EHR to assist in the collections process. One such service is a series of collections letters that can be sent directly from your EHR.
- If necessary, we’ll recommend either a write-off of the uncollectable balances, or transfer the balance to a collection agency to pursue the money. In either case, the balance is written off your books. If a collection agency is involved, you will receive a percentage of the balance once collected
Cause #4
Outstanding Balances Past Timely Filing
- All payers have time limits for when you must file a claim, or resubmit if there is an error on a previously submitted and rejected claim. Our first step is to identify and categorize these types of payables to help determine if a rejection is proper and legitimate, and if any balances may be collectable.
- If the collection is not collectable because the filing or resubmission deadline has been missed, we pursue the confirmation from the payer so the balance can officially been written off the books.
- RCM360 will follow up on each claim every 30 days, update the files with notes of what has happened with the follow up, and provide reports to your practice so that you’re always informed.
- As the process begins, we’ll hold weekly calls with the practice to review reports and perform reviews of your KPIs to monitor progress. Moving forward, those calls will be held on a monthly basis.
Resolve Claims
At the heart of every rejected claim lies some sort of error – a slip of the finger, an incorrect code, or missing information. These are all things that can lead to rejection. And rejection means a delay in payment, so it’s of utmost importance to get it right the first time. RCM360 can help set up processes to help you do just that, and we’ll also help you clean up an old stockpile of rejected claims you may have lingering in your healthcare organization.
There are several possible causes for rejected claims, and a variety of strategies RCM360 will employ to remedy the situation.
Possible causes for rejected claims:
Cause #1
High Denial Rate
- The RCM360 team will perform a thorough assessment of the denials, identifying the top, most commonly denied codes in your practice and determining why they’re being denied. It could be a case of incorrect documentation, or an incorrect code that’s being entered into the system.
- RCM360 will call each payer on rejected claims to ensure the rejection is legitimate and proper and determine what must be done in order to get it paid.
- A plan will then be created to rectify the situation. This entails:
- Clear definition of codes
- Creation of processes by a certified coder
- Internal training on proper coding
- Ongoing monitoring of rejected claims
- Quick remedy for rejected claims moving forward with rejections addressed within two business days
Cause #2
Lack of Timely Submission of Claims
- RCM360 will analyze claims that were rejected because they weren’t submitted according to the payer’s eligibility timeline. In other words, they were submitted too late.
- Our team will review the lag times to determine where process issues or training needs may exist.
- We’ll develop a plan to streamline the process to help ensure on-time submission, as well as to streamline claim correction and resubmission.
- Ongoing monitoring will be established, and review processes will be implemented to identify and rectify workflow issues more quickly.
Cause #3
Patient Ineligibility
- RCM360 will review and identify any rejections that resulted from patients not being eligible for the service, or not being pre-certified for the service by the insurance company.
- In many cases, these are oversights and can be rectified with the implementation of workflow processes.
- Our team will implement automated eligibility checking and identify process changes to help avoid this type of rejection.
- We’ll then monitor this regularly to identify and resolve the issues as quickly as possible.
Cause #4
Missing Referrals
- In specialty practices, referrals from a primary care physician, as well as pre-authorization for the service, are typically required for a claim to be paid.
- RCM360 will complete a thorough review of this type of denial, identifying the cases and determining a course of action for each.
- Claim engine rules processes will be implemented to quickly flag missing referrals based on payers with high denial rates.
- Ongoing monitoring will be put in place, with regular reporting to address these situations as they arise rather than months later when it may be too late.
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