Top 5 Reasons You Should Outsource Your Medical Billing and Revenue Cycle Management

Given the complexity of Revenue Cycle Management (RCM), many medical practices choose to partner with an RCM company for their billing needs. RCM companies are designed to maximize revenue for medical practices. While there are perks to keeping your billing staff in-house, outsourcing your RCM allows for a team of experts to dedicate their time to properly working claims, successfully appealing claims, accurate coding, timely follow-up, and staying current on ever-changing insurance requirements.

Billing is a primary piece of your practice’s overall revenue cycle management, but that’s not where it ends. An RCM company can help you identify new revenue sources to grow your practice. The professionals at RCM360 have seen it all working with practices and large physicians’ organizations across the country on their medical billing and revenue cycle management needs – and we’ve made a dramatic impact on the cash flow and profitability of the practices we’ve served.

Based on this experience, we’ve compiled a list of the top five reasons you should outsource your billing and revenue cycle management.

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Reason #1: Decrease in Cash Flow

Cash flow is the lifeblood of any business, and your medical practice is no different. If you experience a decrease in cash flow, there are serious issues to be addressed.

• Coding errors are critical to educate your providers on proper coding, or have a certified coder review claims before they’re submitted. Errors lead to rejections, and that means a disruption of your cash flow.
• Elimination of under coding goes a long way to ensure you collect all the money owed to you. It simply doesn’t make sense to underbill for services provided. Adopt proper coding processes to avoid leaving money on the table.
• Claims denials can be caused by coding errors, as discussed above, or there could be other reasons you’re experiencing a high volume of denials. Education in this area is key and this must be addressed on the front end to avoid costing your practice money.

You may be thinking, “we don’t have the people, time, or experience to fix these things.” We know, and you’re not alone. Many practices choose to outsource their RCM for these exact reasons.

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Reason #2: Increasing and Aging Accounts Receivable

Getting your billing out is a great first step, but the most important part of the billing process is collecting the money! Many practices don’t dedicate the time and resources needed to manage their accounts receivables. They find themselves with an increasing list of monies owed, and that list just keeps getting older and older. This isn’t something to be taken lightly, and RCM360 can take key actions to help practices fix this problem.

• Denial management is key to keeping your A/R under control. The longer a denial sits unworked, the further your A/R will age. The longer your A/R ages, the harder it is to collect. Insurance requirements are constantly changing, so billers need to be educated and continuously review denials to see where changes can be made on the front end to submit a clean claim on the first pass.
• Timely filing is also a contributing factor when we see practices with increasing A/R. Billers should work with providers to complete notes in a timely manner, but they must also continue to follow up on claims with the insurance companies. The last thing practices want to do is write off balances that that are not collectable due to lack of follow up.

Getting A/R under control takes a lot of time, persistence, and experience. If you don’t have it in-house, you could be walking away from a great deal of money. Outsourcing your RCM may be an opportunity to get paid for the services you’re providing.

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Reason #3: Rejected Claims

Just like billing, getting a claim submitted is only the first step in the process. Getting it submitted correctly, the first time, means you get paid faster (great for cash flow!). But when it’s not submitted properly, it gets rejected and you don’t get paid until it’s right (bad for cash flow!).

Addressing this issue involves putting process in place, and leveraging your EHR, something we do for clients every day:

• Rules and edits should be utilized to help prevent errors. Although they are time consuming and require management, every practice should use them to effectively submit claims.
• Insurance eligibility is another important step, one which helps you eliminate uncollectible revenue from patients with invalid or insufficient insurance benefits.

It’s time consuming, but it’s critical, and it’s something you can’t let go if you want to protect the cash flow and profitability of your practice. RCM360 can work with you to accomplish it.

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Reason #4: Staffing Challenges

Like any business, the operation of a medical practice is highly dependent on having skilled, quality staff in place.

Yet when it comes to billing, you may find challenges with finding, retaining, and managing these professionals:

• Finding candidates is a challenge for many medical practices today. They are finding themselves in an endless cycle of identifying candidates who are qualified to do the job, making hiring decisions, and training those individuals. It costs time and money, and disrupts business continuity for a practice each time a position has to be filled.
• Risk occurs anytime you have individuals dealing with your money. There not only needs to be trust, but there must also be checks and balances in place. If your billing team is stretched too thin or is not being properly managed, you put yourself at risk of embezzlement, misuse of funds, and a host of other financial shenanigans. All of this could be done with your money, and put your business at risk.

Sounds scary, doesn’t it? We’re here to take these types of problems and worry away. You don’t need to hire legions of people (if you can find them); you need to outsource.

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Reason #5: Build a Competitive Strategy

Practices have to think beyond billing and coding to operate a successful business. Local hospitals have become competitors to private practices, and we’ve seen small practices fail because they weren’t proactive about building their business strategy.

Here’s how you can avoid this:

• Market to existing patients by staying top of mind. You can reach out to your existing base of patients with information to enhance their care, or to ensure they’re coming in for routine or follow-up appointments. Not only will this help you provide better care on a regular basis, it can also help you retain them as a patient.
• Attract new patients by consider what will make a patient want to choose your practice over another, and how you will reach them. These are the types of key questions you should ask yourself to implement a business plan.
• Add new revenue streams by bringing services in-house. What are the primary things you typically refer out? Making an investment in bringing those services in-house may allow you to quickly recoup that investment and increase revenue to your practice. And again, you keep your patients coming back – which is great for retention and consistency in their care.
• Manage your fee schedules. What technologies do you have in place to ensure you are paid at your contracted rate? It’s hard enough to get patients in the door, so it’s critical to make sure you’re being paid accurately for the services you’re providing.

If you don’t quite know where to start, RCM360 is here to help. We know how to bring your revenue cycle management full cycle to help you grow the services provided at the top of the funnel and grow the amount you collect for the work you’re doing. It’s a win-win all around made possible by outsourcing your RCM.

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Outsource Your Medical Billing and Revenue Cycle Management with RCM360

RCM360 is a team of billing and optimization specialists with years of experience helping practices with their revenue cycle management needs.  We’ve worked with hundreds of providers and seen firsthand the challenges they face with their billing, collections, and revenue growth strategies. That experience has allowed us to develop a solution which routinely results in increased cash flow, reduction in rejected claims and more efficient billing and collection processes.  Leverage the RCM360 team to improve the financial health of your practice. Contact us today!