RCM services—the full range of front back office tasks leading up to improved clinic management have seen remarkable inroads in 2020. The sudden shift in treatment demand (following COVID-19) forced many practitioners in healthcare and the American medical industry to seek more efficient ways of running clinic administration.
But how do improvements in the revenue cycle management (RCM) of a clinic improve patient care? In 2020 it has, and in this blog, we will show you how.
FRONT OFFICE AS A FUNCTION OF RCM SERVICES
Appointment Scheduling Done Better
A great point of frustration for patients is the non-availability (or delayed availability) of doctors. The more qualified the doctor, the more specialized the treatment sought, the more frustrating the effort.
For healthcare providers, the frustration is two-fold: One, patients book an appointment, but fail to show up. That leaves many empty slots in what could have otherwise been a productive day. Second, is when patients do show up, but not on time—even five minutes can delay their consult, as medical staff need to collect vitals like blood pressure, weight etc first.
Clinics that subscribe to end-to-end RCM services discover that all these problems are solved up front—literally. RCM services that provide holistic solutions also offer appointment scheduling services.
What’s unique about these appointment scheduling services is that they take the burden of setting, confirming, reminding, and managing appointments off the physician or practice manager.
Patient care improves when an outsourced team of specialists is responsible for:
Scientific scheduling techniques mean a balanced, energized day for healthcare providers. They can list their preferences in terms of STF (Shortest Task First), FCFS (First Come First Serve)—in case of OPD services and so on.
Verification Of Benefits (VoB)
Doctors have often pursued lengthy and complicated lines of treatment—only to be denied reimbursement by the insurance company later on. In some incidents, this is because of the insurance company. In others, the responsibility lies with the patient.
Patients often lose sight of expired plans, treatment not covered under their insurance program. And on some occasions, they forget their end of co-payments. Each situation can be embarrassing for the patient, and a demotivating force for the physician.
But with good RCM services, it doesn’t have to be this way.
The American medical industry is organized to ensure that no one goes without. Every patient earns the right to quality healthcare, and every doctor deserves to be fully reimbursed for healthcare services rendered.
The medical coding and billing system goes a long way to ensure that the gap between treatment sought and provided remains narrow.
How do RCM services help here?
The payments team (which is the core of back office system in RCM services) works closely with front office team members to conduct a series of verifications.
These include:
- Currency of coverage (Is the patient subscribed to a policy that’s still valid, or has it expired)?
Verification of benefits isn’t merely a safeguard against healthcare fraud. It establishes confidence, trust and commitment between the patient and the healthcare provider. Without having to worry about claims denials or incorrect patient data, the doctor can concentrate on providing treatment. This focus is at the core of patient centered care.
Better Record Keeping
Digitizing functions like appointment scheduling and VOB provides another benefit: It provides full visibility. Busy physicians can’t always keep track of each patient visiting their clinics. Even if they remember each visit, keeping track of prognosis can be hard…and costly. Compromised patient care and lawsuits aren’t the only outcomes of incorrect diagnoses. But they are definitely the worst ones.
A staunch safeguard against both is: Reporting. The best revenue cycle management services offer reporting and analytics that help decision makers get a single view of Clinic Operations (ClinicOps). What can be better than in-depth insights you can get at a glance?
Analytics and reporting solutions help keep healthcare providers up-to-date on individual and general patient categories.
No more digging through pen-and-paper files, untidy notes or scrambling to recover prescription notes!
Driving Better Healthcare Decisions
Whether you’re relying on a medical billing outsourcing company or aligning with a partner service, revenue cycle management will help drive better decisions for your clinic. From an administrative point of view, RCM services are adept at trimming excess fat, exposing process loopholes and helping you overcome administrative glitches that could impede your collections and overall profitability.
For instance, your appointment scheduling dashboards alone can point to many things:
- Increase in patient traffic from a specific demographic (e.g. Teenage males)
- Escalation in demand for a non-seasonal ailment
- Decrease in demand for other services (e.g. Infectious diseases)
- Longer recovery period for routine procedures
- Irregularities in follow-up visits
Depending on how material the trend is, each one can drive your clinic practice in a new direction. You may choose to add new healthcare services or pare down on operations.
They will also provide a more realistic horizon on treatment timeline—and payments due.
Physicians are right to work on the side of caution. It’s prudent to proceed with treatment after their credentialing has been completed.
The faster, the more accurate and the smoother the credentialing process is, the more quickly new physicians can embark on providing medical services. And the sooner patients in need can benefit from them.
USING BACK OFFICE SERVICES TO DRIVE BETTER HEALTHCARE
The medical industry is getting more and more enmeshed in complexity as the lines between treatment and healthcare get blurred. From the infusion of technology, to the added sophistication of medical devices and biotechnology to the use of AI in driving healthcare solutions—we understand completely when healthcare providers struggle to stay on track.
Fortunately, a great deal of administrative streamlining comes by way of back office services. Back office services absorb all the processes related to recovering payments—from applying for a reimbursement to taking care of what happens when such a claim is denied.
Again, how does this help patients? Let’s just find out!
So VoB is done. Credentialing is complete. And you’ve been very busy this month, with hardly an empty slot in your calendar.
How do you make sure all this effort is driving clinic profitability? And that too, on time?
Enter the back-office claims management team.
Claims management consists of a series of tasks that ensure your claim for reimbursement was:
- Filed completely and correctly, with all the right codes and patient data
- Submitted on time
- Received by the insurance company or other payor
- Processed in time
A delay in any of the steps above can impede the next stage of patient care. If the patient has failed to provide data on time, or provided incomplete or incorrect data, an unnecessary source of tension is created between him/her and the healthcare provider.
In some cases, reimbursement claims are denied because of spurious submissions.
Onboarding RCM services makes sure this doesn’t happen. Getting an experienced medical billing and coding specialist ensures foremost—that data entry is correct. Second, if there are delays or oversights, it isn’t, colloquially speaking, the “doctor’s headache.”
With RCM services, a professional gets involved and takes charge. This maintains a single line of communication, so that the physician remains unconstrained by these time-consuming, iterative tasks and is free to focus on what really matters.
The patient benefits by delineating the relationship between payment and medical services. No more delaying an appointment in wait for the next paycheck!
Managing Payments
Payment and posting services bridge the gap between accounts receivables and actual collections. Done manually, practice managers or clinic staff may falter with duplicate or missing entries, or incorrect entries. RCM services come equipped with a defined methodology for getting this done—with process reviews at each stage of the process.
Payment records and posting assist with patient care in one more way: They enable you to make quantifiably sound decisions about how you clinic is managed.
What would lead to an increase patient traffic: Expanding your own facility, or renting one in a neighboring county? Based on your practice’s cashflow, when would it be a good time to engage a contractor for the same?
Is it time to bring in a new partner? To what degree would your existing patients benefit from the addition?
You can get answers to these and other questions to improve the patient experience. Not to mention derive lasting rewards from a few adjustments in your clinic practice.
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