Do you find that your outstanding invoices are getting older? Perhaps you’ve sent statements or tried to collect, or even tried to resolve issues with your claims. Or, if you’re like many practices, you may simply not have the time or knowledge to deal with receivables in a timely manner. It’s detrimental to your practice – you know this, but you’re not quite sure what to do next….
RCM360® is your answer. Our team knows how to pinpoint the root cause of your medical practice’s increasing and aging AR, and has the skills and knowledge to create a plan to rectify the situation. Common causes, and what we can do about them, include:
|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 to ensure all have precise and consistent knowledge
- Creation of processes by a certified coder
- Internal training on proper coding of provided service
- 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 eClinicalWorks to assist in the collections process. One such service is a series of collections letters that can be sent directly from eClinicalWorks.
- 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.