Revenue Cycle Management (RCM) is the financial process that facilities use to manage the administrative and clinical functions associated with claims processing, payment, and revenue generation. It begins when the patient makes the appointment to seek medical services and ends when all claims and patient payments have been collected.

There are many different components involved in RCM and the dynamic is constantly evolving. Providers need to be vigilant, regularly looking for ways that this process can be improved.

Over the next few weeks, we are going to tackle a few challenges that RCM may present and some solutions to help combat these issues.

We will start the series with billing and collections. The complexity of billing and collections causes errors that can lead to uncollected revenue being left on the table. Bad debt accrual is inevitable as a result of ineffective billing.  

According to AMA’s Health Insurance Report Card, there is a 20% error rate in claims submissions. Inaccurate and incomplete claims lead to denials, costly resubmission of claims, and diminished reimbursement. Errors can range from simple clerical mistakes, such as a patient’s name being misspelled, to a more complex error of miscoding a procedure. These can trigger an onset of issues delaying the billing process.

When it comes to collections, sending incorrect bills or a lack of understanding from the patients may result in payments going unpaid. Uncollected bills are expected to climb as consumers take on more financial responsibility for their care. With patient out of pocket expenses increasing 14% from 2017 to 2018, providers need to look at ways to make the collections process more transparent and streamlined for everyone involved.

So how do we combat the issues faced in the billing and collections process? Let’s start with billing errors. It is imperative to have a skilled billing team who are well versed in the claim submissions process. From collecting patient information to making sure claims are accurate, reducing errors will ensure you get your payments quickly and precisely.

Utilizing electronic transactions is beneficial from submitting claims to collecting payments. It makes checking the status of claims easier and faster. Pre-appointment verifications can be done electronically to receive patient responsibility in order to avoid surprise bills for both the patient and practice. Electronic transactions also make it easier and more convenient for patients to pay their bills online.

Another option is to offer payment plans. Not everyone can pay their doctor or hospital bills in full. Having this option relieves the patient of the pressure to pay all at once and provides them with a better experience with your facility. It is important to make the payment reasonable for the patient but also acceptable to your practice’s operation budget.

Having a competent medical billing process in place reduces errors, ensures payments are received without delay, as well as creates a positive patient experience.

Reliance Medical Billing Solutions can assess your billing situation and help find long- or short-term solutions to your billing needs. Contact Reliance at 717-740-2622 or visit our website at www.reliancembs.com to learn more or to request a customized quote of our services.