Don’t be fooled into thinking healthcare providers only need medical billing software to keep cash flowing. Like most things in healthcare, the billing cycle is complex, and it’s likely medical billing software is only telling half the story of your total billing cycle.
In a nutshell, medical billing is the process of submitting claims, following up with payers and receiving payment for services. Medical billing software typically includes the basics to help providers address these three components of the billing cycle. Some software even includes extras like appointment scheduling and electronic billing. But what happens when the essentials don’t provide all the information you need to have a healthy business? After all, healthcare is a business.
Running your healthcare business, and running it well, means you need a holistic view of your revenue cycle, not just part of it. A total revenue cycle management (RCM) solution bridges the gap between your front and back office by streamlining the claims process from the time a patient comes through your door to the time you get the electronic remittance advance (ERA).
An RCM application helps you manage the business side of your organization, getting more money per patient, faster and with much less waste than typically required when collecting payment using conventional methods.
If you’re considering the switch from traditional billing software to an RCM solution, it pays to understand how it will improve your organization, workflow and bottom line.
Before You See the Patient
An RCM solution verifies patient insurance and coverage details before they show up at your door. An advanced eligibility tool will also offer real-time, scheduled and batch eligibility verification to limit rejections and catch coverage changes billing software can’t detect.
Submitting the Claim
Unfortunately, errors happen between the time your patient enters the facility and submitting their claim for payment. These errors can lead to rejected or denied claims billing mistakes like using the wrong ICD-10 code, invalid patient data, or incorrect dates of service. To handle claims submission, a good RCM application has a clearinghouse that electronically scrubs claims for errors so you can fix them. A clearinghouse then submits the cleanest claims possible to payers the first time and on time. Ultimately, it reduces labor costs by lowering the number of times you touch each claim.
Monitoring Reimbursement Post-Visit
Basic billing software can show you denied and rejected claims, but it can’t make sense of your business trends and analyze data. It also can’t help you manage the denials and appeals process. After submission, RCM software will track your claims every step of the way, correct RTPs, assist with ADRs, address denials, and offer invaluable reporting. Reporting, analytics and other business intelligence capabilities are key to strengthening your business with actionable, intuitive data.
For example, a solution that easily exposes the top reason codes applied to rejected and denied claims alerts you to common trends you need to change. You can identify issues that could be solved with stronger patient intake procedures, more staff training or stronger technology.
Benchmarking is a key feature in a viable RCM program. How do your billing and revenue cycle practices compare to other providers and to your own goals month to month? The ability to compare your performance against your peers and the industry is beneficial for developing best practices. Even more advantageous is a solution that allows you to set your own reimbursement and business benchmarks so you stay on track and eliminate unwanted surprises.
Managing Unpaid Claims
Many healthcare providers lose money that’s rightfully theirs due to claims that haven’t been formally denied but are still pending. For some providers, tracking these unpaid claims without an RCM tool is far more trouble than the claims are worth.
Why leave money on the table that’s due to you? You don’t have to, thankfully, with the right system. Using an RCM application helps you easily stay on top of anticipated reimbursement and directs you to take action at the right time to get paid. Also, it will give you the info you need to make financial projections and budgeting decisions.
Get the Whole Story
Most healthcare providers would significantly benefit using an RCM system to tell the whole story, rather than basic billing software that leaves gaps in information and the process.
Additionally, a more robust solution connects your entire operation for better communication, automates and speeds up processes and pays for itself by identifying and helping you retrieve cash that you otherwise would have lost.