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system will warn you of missing charges.
THE MAIN REASON WHY RCM IS IMPORTANT
CMS rejects nearly 26 percent of all claims and up to 40 percent of those claims are never resubmitted.2 This can result in lost revenue of up to 10 percent per physician. However, debt write-offs.
An RCM company or partner can help you address problems
can help many medical practices in managing the health care revenue cycle with a concept called Revenue Cycle Optimization (RCO). RCO is the combined use of advanced software technology between the practice and the RCM partner working cooperatively to collect the maximum legal reimbursement from payers and patients in the shortest possible time. Some practices substantially reduce clerical costs in addition to improving collections with professional RCM services.
The key to the success of this approach is sharing advanced technology by both parties in a cooperative manner and the division of specialized labor so that the practice concentrates on issues that they do best and an RCM partner, using their billing knowledge, manages claims to send bills and follow-up with insurance carriers and patients to collect and post payments
to maximize revenue. This is a cooperative RCM approach in which the practice enters patient appointments and demographic information, checks patient insurance eligibility, and captures charges into the electronic charge slip within the EHR.
REVENUE CYCLE AND SHARED PRACTICE MANAGEMENT SOFTWARE
1 First, the RCM partner enters the charges into the shared practice management software. Claims are scrubbed for errors and then electronically transmitted. They are not keypunched or manually reviewed at the insurance carrier and, therefore, less likely to be rejected. Studies show practices that bill electronically experience 21 percent fewer rejections.3
2 Second, within 48 hours the RCM partner is electronically Rejected claims are corrected and resubmitted.
3 Third, electronically submitted claims are typically paid faster. By law, Medicare must pay an electronic claim in 14 days. The same paper claim wouldn’t be paid until day 26.3
4 Fourth, the RCM partner will follow up on insurance claims. Claims are automatically tracked and if a claim is not paid, the RCM partner contacts the carrier, reviews the charge, and if necessary, resubmits the claim.
5 Fifth, after the practice receives payment the RCM partner can check the contracted fees to ensure that the physician is paid correctly and automatically bill the secondary carrier or patient.
6 Sixth, RCM partners either manually or electronically carriers, and balance bill your patients, saving most practices hundreds of labor hours each year.
WHAT TO LOOK FOR IN AN RCM PARTNER
Do they provide an on-site client services manager?
A client manager is critical to your success because this
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Del Med J | April 2016 | Vol. 88 | No. 4
