Page 25 - Delaware Medical Journal - April 2016
P. 25
BUSINESS OF MEDICINE
the Affordable Care Act mean that your staff needs to keep
up with multiple insurance changes, rules and regulations of multiple insurance plans, and to check patient eligibility every time you have an encounter. If your practice plans to become a Patient Centered Medical Home (PCMH) or an Accountable Care Organization (ACO) there are more work requirements to manage and information to collect.
A recent Medical Economics article1 states “as doctors have to meet more and more requirements to get paid, they need to rely heavily on their staff to collect and enter data that insurers will review and use to determine payments.” RCM is not about the elimination of labor, rather it’s about how to use your people more productively on items that matter, and more importantly
not needing to add additional staff to keep up with the workload. Also, there is a concept about the quality of work. For example, sitting on hold for 30 minutes on an insurance payer phone line
is low quality work and not very satisfying to the person doing the job. Helping a patient solve a problem or helping the practice stressful and more satisfying to your staff members.
The goal of an RCM program is the division of labor between your staff and an RCM company through the use of shared advanced software. Your staff is still involved in registering patients, checking eligibility, making appointments, and entering charges. However, your staff will have more time to work on much more important patient and practice related items when the collecting, and following up with insurance companies and patients to get you paid quickly and accurately. Many practices revenue increases because insurance and patient claims are consistently monitored in a timely and organized approach by a professional and experienced RCM company.
The health care revenue cycle is more than just billing and collecting fees. It includes the entire patient process from patient registration pre-encounter, patient/physician encounter, back knowledgeable and dedicated administrative and clinical staff cycle is becoming more complex and time consuming with additional health care regulations and processes, especially in smaller medical practices. Many medical practices would prefer
to concentrate on the clinical side of the medical practice (patient pre-registration and the patient/physician encounter) and to be keys to successful RCM.
PROBLEMS WITH THE HEALTH CARE REVENUE CYCLE
be many different reasons for the problem. Here are a few of the most common issues:
Staff has not been properly trained.
Optimizing your revenue cycle is like a supply chain; if one person in the chain does their job incorrectly, it will affect
the outcome of the rest of the chain. Coding errors, incorrect
or missing patient data (insurance information, patient demographics, etc.), or simply a failure to understand the payer requirements can result in your staff making costly mistakes and less revenue.
Lack of communication between staff.
managers must remain open and weekly meetings should occur collections, and revenue.
Does your staff check patient eligibility and copay amounts before the patient arrives? Do you check for missing charges against your charge slips? How long does it take your staff to can end up missing steps and/or forgetting tasks which results in increased errors and delays in payments.
Not following up with rejections.
Submitting claims is the easy part. If your staff is not checking your clean claims reports for rejected or missing claims that means the claim did not go through and it will never be paid. Many practices submit claims without checking to see if they were accepted.
Lost charges.
Often physicians see patients but the charge is never entered
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