In this series, we are talking about common challenges in Revenue Cycle Management (RCM) that can result in the loss of revenue. We are also looking at solutions to overcome these challenges and achieve financial success.

Last week we dove into billing and collections and suggested some positive ways to streamline the billing process. Today, we are going to talk about untrained or undertrained staff and the importance each team member makes to the entire RCM cycle.

Administrative staff play an integral role in establishing an efficient claims cycle that reduces the days a claim is in A/R and maximizes the reimbursement amount. Having a staff that is inexperienced can lead to a disorganized billing process, contributing to errors in clinical documentation as well as other areas that result in loss of revenue.

Insurance companies are very strict on correct medical billing and coding practices. Even the smallest mistake can cause a claim to be rejected. These errors can begin with gathering incorrect or incomplete demographic information which can result in the inability to create and collect an insurance claim. Knowing what information is needed is vital in the completion of the billing cycle.

Being able to keep up with changes to compliance can also be difficult for practices and their staff. It’s no secret that the medical coding world is always changing. There are new codes and guidelines coming out each year. It is extremely difficult for internal staff to stay on top of regulatory requirements and fee coding.

Another area staff need to be trained in is monitoring the entire claims cycle. It is important to make sure that claims are paid correctly and to continuously track possible errors or coding issues. Being able to correct claims that are denied or rejected quickly and accurately is crucial to minimize the time in A/R. Sometimes that requires a phone call to the insurance company or filing an appeal.

So how do we make sure our staff is fully prepared? One great option is training staff to not only know their specific tasks, but also how it fits into the broader revenue cycle management. Knowing how one person impacts another’s performance allows everyone to do their job more thoroughly and productively.

Hiring a full-time billing team is also essential. Staff can become overwhelmed with too many tasks, such as scheduling patients, answering phone calls, and collecting payments from patients at checkout. Having a dedicated staff handling the billing process who are free from distractions allows your front-end staff to focus on the primary objective to provide better care to patients.

Integrating a medical billing company may be a great choice for your practice. This can help you allocate your financial and human resources more efficiently. Having a team of insurance specialists who are highly trained in RCM can relieve you and your staff of the time-consuming and stressful task of medical billing.

It is beneficial for providers to employ a capable, well-trained staff that understands the importance of quality and integrity of the data they deal with daily. This will reduce billing errors and ensures the whole process will run more efficiently.

Reliance Medical Billing Solutions can work with you to assess your billing situation and find solutions to your billing needs. Contact us today at 717-740-2622 or visit our website at www.reliancembs.com to learn more and to receive a customized quote of our services.