Revenue cycle management (RCM) is exceedingly important in the healthcare industry. Medical practices and hospitals rely on the effectiveness of their billing operations to survive. While healthcare might be the top priority, medical practices are still businesses and need to turn a profit to continue to exist.
However, as any healthcare professional knows, billing is a complicated process filled with delays and uncertainties. There are many opportunities for things to go wrong, from coding errors to rejections, and there are plenty of times practices are unable to collect some (or all) of what they are entitled to. It can also require a great deal of manpower to follow up with insurance companies and patients regarding denied or unpaid claims, increasing the amount of time it takes to get paid while leaving revenue hanging in the balance.
As the owner of a medical practice, you have one major choice to make regarding billing from the very start: do you run a billing operation through your in-house staff, or outsource it to a medical billing service which will handle RCM for you?
If you opt to have your own staff cover medical billing, you'll be responsible for coding, submitting and following up on claims. That means you'll need a certified medical coder on staff, as well as an established process that ensures claims are created, scrubbed, and submitted in a timely fashion. If a claim languishes or is rejected by the company, you'll need staff to manage that as well.
It's also crucial to stay on top of the ever-changing regulatory framework and new policies. For example, as of 2018, ICD-10 coding has been implemented across the industry. Keeping billing in-house is often cheaper and gives you more control over the process, but for a small practice that already needs its staff to wear many hats, billing can be time-consuming and complex. Worse yet, if the proper time and attention are not given to the billing process, you might end up losing out on a substantial amount of money.
Medical billing services can help alleviate that burden, but it might end up being more expensive. Often, for a percentage of your collections or a subscription fee, a medical billing service can take over your revenue cycle management and free up your staff to focus on other tasks. A good medical billing service will increase your collection rate, reduce rejections and denials, and even provide an analysis of your accounts receivable. You'll typically be able to generate on-demand reports and view your day-to-day finances through the company's software as well.
At best, outsourcing your revenue cycle management can result in more money for your practice without allocating your own staff to complete the arduous tasks of coding and billing. But how can you possibly know which billing service to trust with something as important as your revenue cycle management?
Regardless of which option you choose you're going to need practice management software. If you choose to outsource your billing, discuss with your billing partner which software they are familiar with. You'll also need to ensure that software is interoperable with your electronic health record (EHR) system.
At ProMD, we are experts in medical billing and collections. Call us today for a complimentary medical billing assessment. Your medical practice deserves it!