You’re doing great work with patients. Physicians and staff are busy. Perhaps you’re even serving increasing numbers of patients. Yet your cash flow is suffering, and you may feel overwhelmed by thinking through how to fix it. RCM360® has experience with even the most challenging of cash flow situations, in some cases even doubling a practice’s receipts within the first month. And we don’t just target the easy money – we focus on the big picture because that’s where the greatest impact is.
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.
|Cause #1: Under Coding
- We’ve found a number of practices who are performing services for which a higher code (higher fee) applies, but who are coding those services at a lower rate. This means you’re performing the work, but not being appropriately paid for it.
- 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.