Outsourcing the revenue cycle management to competent offshore companies is picking up in the US healthcare industry in current times. While there are many companies in the market who are ready to serve you, not all of them have the expertise to handle difficult situations. When investing and trusting a third vendor in the management of your company, you must be sure of what to expect from them. That is why you need to know what are the rules followed by the top revenue cycle management companies.

It does not matter if you have a stand-alone individual clinic or a multispecialty hospital chain. Significant changes in the revenue cycle management will be one of the crucial reasons for your expansion and success. Make sure you choose the right vendor for yourself by knowing if they follow these rules abided by the top revenue cycle management companies.

1.Primary Identification of Billing and Collection Errors:

Billing and collections form the basics of the revenue cycle. Usually experienced teams from the outsourcing companies are appointed to look at the existing state of affairs in the healthcare organization. They are experts at identifying the specific issues that need immediate attention. In this phase, they might want to look at the previous papers to calculate specific metrics. These metrics will help the resolution approach to be client-specific, rather than run-of-the-mill concepts.

2.Segregation of Issues:

The top revenue cycle management companies are known to segregate the issues according to the level of urgency. While some problems can be solved within a short span of time, others need a more long-term approach. Some of the common problems identified here are:

  • Increased claim denials
  • Excessive delays in payments
  • Decreased patient collections
  • Increased number of days in Accounts Receivables
  • Ineffective Follow-Up method
  • Absence of repeatable processes
  • Lesser use of automation and greater use of manual entry

3.Dealing with Issues of Multiple Specialties:

Billing and coding are difficult processes that need acute attention from the staff members. It becomes even more cumbersome when the different medical specialties are involved. You need properly experienced professionals to take care of the recurring problems in different departments. It is often not possible to divide the staff according to the specialty due to a shortage in the team. The top revenue cycle management companies appoint specific domain experts to handle the different specialty billing and coding. This is more helpful in the case of multispecialty clinics or hospitals. With a circular approach, problem identification and solving become easier.

4.Updating the Physician Fee Schedule:

Physician fee schedule updates are crucial to improve the increase in collections. More often than not, it is found that healthcare organizations have failed to upgrade the fee schedules. This lowers the collection value for the services rendered. The experienced RCM companies make sure that the fee schedules are in line with the market rates. They must be individually compared in the case of multispecialty hospitals and changed accordingly.

5.Improve Claim Accuracy:

When all the immediate issues have been resolved, the top revenue cycle management companies will focus on more long-term goals. Getting down the claim denial rate to an acceptable limit is one of them. They make sure that the pre-mediated processes are articulated and followed by the team members. This helps in reducing unnecessary errors and automatically improves the claim accuracy. The goal of the company is to submit a clean claim in the first time itself. This will also reduce the time spent on handling claim denials.

6.Regular Staff Training Programs:

Staff training programs are mandatory if you want to achieve the required claim accuracy threshold. The top revenue cycle management companies help the healthcare organizations to collaborate with leading experts in this field to design the most effective staff training programs. Through these programs, the staff handling the groundwork of billing and coding, are trained to easily navigate through the regular challenges faced. The use of updated codes and refined billing methods helps to bring down the claim denial rate. These training programs keep the staff in the loop about the same.

7.Proper Use of Advanced Technology:

Using advanced technology and software tools helps organizations pin down the problems to the most granular levels. For example, there are certain homegrown software tools by the top revenue cycle management companies which make use of great loads of healthcare data and provide specific analytics reports. These reports can be customized according to the needs of the organization’s needs. Then the professionals can take necessary action to rectify the errors and improve the highlighted issues. All this is done efficiently in a much lesser time frame with the help of technological tools, which otherwise would take too much time to get completed manually.

8.Ready to Face Unknown Challenges:

This is one point that helps the top revenue cycle management companies to differentiate themselves from the rest in the market. With the growing uncertainty in the global arena and increased pressure on the healthcare system, vendors need to be on the top of their game to face any unknown challenge coming their way. The only way certain companies gear up for these challenges is by keeping themselves updated on every latest industry development. They follow the best practices in the business, necessary to maintain a consistent performance.

Apart from all these rules, the top revenue cycle management companies treat the unique needs of the individual clients in a different way. They understand that the goals of one organization are different than the others. Keeping that in mind, they design tailor-made customized plans for each of the organizations. The budgets of the organizations might also be different. While one might be looking to solve a very specific issue, others might be looking for end-to-end revenue cycle management. The leading companies are proficient in all these situations.

Hope this blog helped you to understand what kind of rules the top revenue cycle management companies follow. Do you think we missed out on some points? Comment down below and we will definitely consider adding them to the list. Do subscribe to our blog to get regular updates on healthcare, management, and technology. Follow us on Twitter, Facebook, Instagram, and LinkedIn for daily notifications.