The typical person’s view of a medical provider’s income has changed from that of the untiring and understanding country “doc” who treated families like “chickens” to that of the posh office entrepreneur who works less and charges more. In the past, that first perception was not far off from being true; however, the second perception is very different from the truth. The average medical practice is actually under pressure from both sides today, with rising costs merely to stay in business and reduced fees to reward harder performance.
The Current Financial Situation of the Medical Industry: Revenue Cycle Management
The fact that it is getting harder and harder to get paid in a reasonable amount of time for services already provided just serves to exacerbate this economic crunch for the majority of suppliers. Unbeknownst to many, there are numerous medical practices in existence today that struggle to make ends meet and cannot afford to even temporarily experience a decline in revenue. It seems improbable, doesn’t it? It happens more often than you might imagine.
More physicians are departing earlier. Practices are functioning as workers and selling out to the neighborhood hospitals. Additionally, some healthcare professionals choose to leave their line of work and pursue careers in research, education, or another industry that pays well rather than continuing to uphold their formerly highly regarded entrepreneurial status. Unfortunately, the average patient will lose out in this situation since both the quality and accessibility of healthcare will be compromised.
But things don’t need to be this way. The medical professional may return to the exam room, where they belong, rather than pacing the floor with the staff to settle thousands of dollars in unpaid claims and patient balances. This is possible because of technology and “good old American know-how.”
A Different Approach to Revenue Cycle Management for the Local Medical Office
While the government and insurance companies are making it more and more challenging to get paid for services in a proper and timely manner, there are “partnering” options that ease this load while still costing the practice far less than “doing it alone.” Contrary to popular opinion, the medical provider also is not required to cede control of the financial and patient communication processes to an impartial third party, whose abilities and procedures might not even be any better than those of a modern 9–5 office worker.
There are flat-rate, low-cost programs offered by knowledgeable, well-known specialists who routinely prepare “clean,” nearly pre-approved insurance claims and maintain extremely delicate patient relations-based contact for unpaid amounts. Thousands of providers today praise their tried-and-true systems, some of whom assert they couldn’t stay in business without the prompt and correct invoicing, claim “scrubbing,” and prompt follow-up these partners offer their medical clientele.
The future of revenue cycle management is now.
Billing and collection have been replaced by the new term, revenue cycle management (RCM). And much as smartphones have surpassed phone booths in terms of communications capability, revenue cycle management has enhanced conventional billing and collection procedures. Professional RCM Texas can take advantage of thousands of “paid” claims for particular services and submit a provider’s claims correctly the first time by using rules engines and other cutting-edge software techniques. Over 90% of the time, this results in prompt reimbursement for the provider.
The remaining “denied” or “rejected” claims are also handled swiftly by way of prompt, prioritized follow-up. Unresolved claims are processed more quickly using a proven “legal contact” system, as opposed to depending solely on a back room receptionist waiting on hold to speak to payers, so that payers actually reply (sometimes proactively).
These professionals ensure that the insurance billing and reimbursement process is automated, accurate, and in full compliance for maximum payment. They also significantly shorten the patient payment cycle by making highly sensitive patient contact as early in the payment cycle as possible and as often as necessary.
Overall, these third-party collaborators ensure that no patient statements are ever processed late or allowed to fall between the cracks.The ever-increasing patient-responsible portions of medical services must be paid promptly, or they must be identified for an installment payment plan or more active collection operations. Systematic and high-touch follow-up assures this.
Fortunately, the use of last resort bad debt or collections is far less common as a result of the methods used by these experts in managing receivables for medical practices during both the insurance reimbursement cycle and the patient-responsible cycle.