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

Given the complexity of revenue cycle management (RCM) today, many medical practices are now partnering with an RCM company for their billing needs.  RCM companies are designed to maximize revenue for medical practices.  While some would say there are perks to having in-house billing staff, it’s not likely a medical practice has enough man power to properly work claims, motivation to successfully appeal claims, code accurately, provide timely follow up, or keep staff current with the 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 many things as we’ve worked 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:

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, issues that we at RCM360 can help you correct:

  • Coding errors – it’s 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 – it simply doesn’t make sense to underbill for services provided. You’re leaving money on the table. Adopt proper coding processes to ensure you collect all the money owed to you.
  • Denials – these could 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. Denials cost practices money!

Now that we’ve covered all that, you may be thinking: “we don’t have the people, time or experience to fix these things.” We know, and you’re not alone. That’s why you should outsource.

Reason #2: Increasing and Aging A/R

You’ve got your billing out. That’s 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 there are some key things we help practices do to fix this problem:

  • Denial management – this 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 always changing, 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 – this is also a contributing factor when we see practices with increasing A/R. Billers should be working with providers to complete notes in a timely manner but also continue to follow up on claims with the insurance companies.  The last thing a practice wants to do is write off balances that should have been collected, but due to lack of follow up is no longer collectable.

Again, we acknowledge that this takes a lot of time, persistence, and experience to get these things under control. If you don’t have it in-house, you’re walking away from a great deal of money. Outsource it and get paid for the services you’re providing.

Reason #3: Rejected Claims

Just like billing, getting a claim submitted is just 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 – these should be utilized to help prevent errors. Although they are time consuming and require management, every practice should be using them to effectively submit claims.
  • Insurance Eligibility – this is another important step, one which helps you eliminate uncollectible revenue from patients with invalid or insufficient insurance benefits.

Yes, it’s time consuming (if you’ll notice we acknowledge that in bullet one above). 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. We can get it done and take the work off your hands.

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 – medical practices today 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 – when you have individuals dealing with your money, there not only needs to be trust, there must 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 not here to scare you, we’re just 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.

Reason #5: Build a Competitive Strategy

Practices are having to think beyond billing and coding to operate a successful business.  Competing against your local hospital is something all private practices are now facing.  We’ve seen small practices fail because they weren’t proactive about building their business strategy. Here’s what you need to do to avoid this:

  • Market to existing patients – how often are you touching your existing base of patients with information to enhance their care, or to ensure they’re coming in for routine or follow-up appointments? Staying top-of-mind with your patients will help you provide better care on a regular basis, and help you retain them as a patient.
  • Attract New Patients – what will make a patient want to choose your practice over another, and how will you reach them? These are the types of key questions you should be asking yourself to implement a plan.
  • Add New Revenue Streams – what are the primary things you typically refer out? If you invested in bringing those services in-house, you may be able 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 getting 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, that’s OK. We do. 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 that’s all possible when you outsource.

Outsource Your Medical Billing and Revenue Cycle Management with RCM360

RCM360 is a team of eClinicalWorks 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 to get started.