The life cycle of a medical claim is prone to a number of challenges on its journey. The success behind healthcare RCM services is that they understand each of these challenges. With prior planning and engaging strategies, they troubleshoot these challenges for the better. In a circulating financial establishment like the healthcare revenue cycle, every step is crucial. Many at times, it is beyond the understanding of the provider. This demands external help for taking the practice forward in a profitable way.
Most common challenges with RCM
Let us brief on the most common ones out there.
Patient check-in challenges
Since the healthcare industry has evolved into a more patient cantered entity, the front desk at practices requires empowering to do more. Since it is the initial point of contact for the patient with the facility, every single communication matters. Information collected at this point is very crucial for the claim to get accepted in the first place.
Talking about acceptability, coverage verification at the front desk is key. Practices often lose money, due to mismanagement of eligibility verifications at the front desk. Sometimes, the patient himself/herself may not be aware that their insurance subscription has expired or the payer has altered the treatments covered under that plan. Sometimes errors happen while documenting insurance IDs, dates, payer information and more. Yet another scenario is when the patient is subscribed to a payer who doesn’t have your facility or provider listed in their network.
Healthcare RCM services strongly work on preauthorization’s and eligibility verifications. Having the insurance data and coverage verified beforehand eliminates a number of problems in future. For starters, the provider can rest assured that they will be paid for the services. Secondly, the front desk staff have more clarity to educate the patient on payment, treatment options and co-pay collection.
Data handling discrepancies
Each day, a baffling amount of data is brought in with every patient visit. The process for reimbursement starts when the patient makes an appointment for the first time. There is a lot of essential data input required at this stage. For instance, one needs to take down the patient demographics, insurance information, medical history and more. Moving on to meeting the provider, there is health charts, referrals and prescriptions involved.
This is only the starting of a claim process. The main part of the RCM which converts services to billable revenue actually starts with coding. Healthcare RCM services take particular care at getting the codes right the first time, because it is the most crucial step for a claim. Breaches in data has become a common occurrence at every stage. Knowingly or unknowingly, millions of cases are filed these days on compromising personal data on birthdates, mailing addresses, personal data like social security number and employment IDs. This is highly unacceptable and considered critical offenses.
Healthcare RCM services employ new-age technology in data handling ad documentation. Everything is cloud based for easy accessibility but highly secure with protective measures implied. Additionally, the system is integrated to allow manipulation of data to suit all the other functions leading to claim processing. Any amount of healthcare data can be retrieved easily, reviewed, modified and ported among providers in a better and responsible manner.
Challenges with claim denials
Out of hundred claims sent out from a small to medium practice in a month a considerable percentage get denied of payment. Now this could be due to various reasons. Whatever may the case, a denied claim is a service unpaid, and collecting the entire claim amount from the patient is practically impossible and unfair. Many practices have gone out of business after facing frequent claim denials. Which is why denials should be taken very seriously.
Healthcare RCM services employ a special team of people to look into claim denials. Unlike the in-house billing mechanisms, they have systematic approach to all the claims sent out for payer approval. Also, The strategy is to track the claims on every stage to make sure reimbursement is received and denied claims are dealt with at the earliest. However, Each claim denial is analysed for reason causing denial and sorted out. If they find a pattern to frequent denials, they alert the providers to make the necessary improvements at billing process. And if the claims are denied without valid reasons. They will equip you confront the insurance payers with appeals based on legal grounds.
Healthcare RCM services for workflow enhancement
With right fusion of technology and expert resources, RCM services can aid practices stay profitable. They mainly work in two ways. One is to help you eliminate possible pitfalls in the process which could affect your revenue inflow gradually. Also, The above-mentioned challenges are only a few landmines that could disturb the revenue cycle. Frankly, there are more. With periodic audits and effective recommendations, they make sure that the practice’s expenses stay lower than their bottom lines.
Tracking issues, sorting them out and getting the workflow streamlined takes time. And with the right back up of healthcare RCM services, it can be achieved in a shorter span of time.