March 2018

Benefits of Outsourced Medical Billing & Revenue Cycle Management

By : Paul Visser  

IF YOU FIND IT MORE DIFFICULT TO MANAGE YOUR MEDICAL PRACTICE WHILE MAINTAINING THE COMPLEXITY OF YOUR REVENUE CYCLE MANAGEMENT...

 WHY NOT CONSIDER OUTSOURCING?


Saves Time and Resources

It takes a great deal of time to hire, train, and maintain a revenue cycle management (RCM) staff. With the ever-changing regulations and protocols in the healthcare industry, outsourcing relieves your business of these burdens and allows you to focus on the core of your medical practice.

Enhances Revenue Generation

An RCM service will be able to generate a higher practice income through efficiencies of scale, broader experience with payors, resources dedicated to denial management, and self-pay follow-up, even after calculating the fees.

Decrease Days in A/R

Lack of follow up is a major contributor in lost revenue. Contributing factors such as timely filing issues, contractual allowances and write offs result in an increase in days in A/R.

Monthly Reporting

A contemporary RCM service will provide customized monthly reports and analytics that offer a deeper look at key metrics, allowing the organization to make better strategic decisions. This should include provider productivity, coding methods, resource management, enhanced patient care, MACRA / MIPS measurements / reporting and a myriad other practice specific ones.

 

Detailed Information (Cost/Utilization Patterns to Assist in Contract Negotiations)

Negotiating with payors in today’s environment is not only a tedious process, but puts a tremendous strain on providers and their management team. Having detailed, empirical historical information on an ongoing basis is a competitively enabling foundation when negotiating contracts.

Designated Team

A RCM should be your “Business Partner”, not your “Billing Company”. Clients should have dedicated personnel to handle your account almost as if they were your own employees.

Single Point of Accountability

When outsourcing, you have an accredited organization focused on the highest level of performance while providing checks and balances, making sure there are no inconsistencies. This allows for a more efficient billing process that offers a one stop solution.

Cost of Building an Internal Billing Operation

The costs and personnel complexities associated with implementing and running an internal billing operation is very high. A billing administrator is required to hire, train, certify and carry out a compliance plan. The average cost of recruiting, hiring and training a new employee is $3,500 (that does not include the decreased production caused by turnover). Technology, (hardware/software) resources, salary, benefits and office space are just a few contributing factors to the overwhelming expense of in house billing.

Government Protocols

With the complex regulatory environment in the healthcare industry, the demands for billing knowledge and experience have become overwhelming for healthcare providers. Full service billing services are in demand partly because of their efficient administrative processes, HIPAA compliance, and their ability to stay contemporary with regulations and requirements.

Technology

End to End Management of Information Technology (IT) includes the ability to meet the demand for skilled IT personnel, continuous assessment of your application (Industry Standards, HIPAA compliance, Cloud based software), hardware, network, heating, ventilation, HVAC, power, security, staffing, policies, procedures, upgrades, backups, monthly maintenance fees and the ability to integrate various systems and deploy new technologies.

Offsite backups are required by HIPAA. And, an internal data backup plan is also required. You must establish and implement procedures to create and maintain retrievable exact copies of electronic protected health information.

Billing Business is Different From Your Core Business

Medical Billing is complex and requires 100% of your staff members time. Practices are looking to full service billing partners to allow the practice to focus on quality patient care and letting the billing partner reduce the number of rejected, denied and missing claims to an acceptable level (nationally around 34% down to 2% or less)

Continuous Change in Healthcare Regulations

With the constant change in health regulations, providers no longer have the time and resources to dedicate to reading material, checking websites, interacting with payers and attending industry seminars. A quality Revenue Cycle Management (CRM) service staff will stay current on all of the aforementioned disciplines. Our EHR cloud based solutions help you coordinate your patient’s care and comply with healthcare reform demands like MIPS (Merit-Based Incentive Payment systems) requirements, population health needs, and other value-based care incentives.

 

FACT

FACT

FACT

3%

28%

16%

Of surveyed health executives felt their organization was highly prepared for the transition to value-based payment methods

Of a physician’s time is spent on non-clinical paperwork due to poor workflow design

Of all physicians can view, download, and transmit patient records to their patients

 

When Does the Merit-based Incentive Payment System Officially Begin?

From www.cms.gov

 

2017

March 31, 2018

Feedback

January 1, 2019

Performance year

Data Submission

 

Payment Adjustment

Performance:

The first performance period opens January 1, 2017 and closes December 31, 2017. During 2017, you will record quality data and how you used technology to support your practice. If an Advanced APM fits your practice, then you can provide care during the year through that model.

Send in performance data:

To potentially earn a positive payment adjustment under MIPS, send in data about the care you provided and how your practice used technology in 2017 to MIPS by the deadline, March 31, 2018. In order to earn the 5% incentive payment for participating in an Advanced APM, just send quality data through your Advanced APM.

Feedback:

Medicare gives you feedback about your performance after you send your data.

Payment:

You may earn a positive MIPS payment adjustment beginning January 1, 2019 if you submit 2017 data by March 31, 2018. If you participate in an Advanced APM in 2017, then you could earn 5% incentive payment in 2019.

 

For more information or a FREE billing review contact: Paul Visser  @ FLB Systems 407.963.7083