GeBBS Healthcare RCM Blog

Outsourcing as a Solution for Revenue Cycle Management (RCM) Continues to Grow at a Rapid Pace

Posted on Wed, Feb 22, 2017 @ 06:00 AM

Facing lower reimbursements and shrinking margins, hospitals are exploring ways to capture more revenue. This has led an increasing number of hospitals across the nation to outsource their revenue cycle management to professional outsourcing companies. This trend was identified in a recent Black Book™ survey, which included responses from 1,309 hospital CFOs and business office leaders. The surveyed revealed that 39.8 percent of U.S. hospitals outsourced their complex claims and revenue cycle management to specialized vendors. That is up from 20.4 percent of hospitals in 2013.

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Hospital billing and collections staffs typically do not have the experience in handling complex revenue cycle management challenges, causing a significant number of claims to be written-off.

Many hospitals are turning to outsourcing to reduce those write-offs and give their organizations a financial boost. According to the Black Book survey, 49 percent of hospital CFOs said outsourcing, including offshoring, is becoming an extremely viable option in 2017 for their organization’s revenue cycle management. Black Book projects the market for outsourced revenue cycle management will grow at a compound annual growth rate of 26.5 percent over the next two years, with the market reaching a value of $9.7 billion by 2018.

The next challenge for hospital financial managers is to choose the right outsourcing partner. CFOs should select an outsourcing partner that has a national recognition as a provider of RCM and HIM solutions. They should choose a company that has an in-depth healthcare industry knowledge and has the expertise to provide innovative, end-to-end solutions that will successfully resolve their complex RCM challenges, while enhancing their overall business operations.

This kind of outsourcing partner can leverage deep industry knowledge and expertise, and provide a partnership approach with comprehensive service offerings. They will deliver highly skilled professionals, robust processes, proprietary workflow engines, and world-class infrastructure to reduce operating and capital costs, recover revenue, improve patient satisfaction, and increase productivity.

This week, the IAOP® has named GeBBS Healthcare Solutions to its 2017 Global 100 Outsourcing List, an annual listing of the world’s best outsourcing service providers. We were recognized as an industry leader in healthcare revenue cycle optimization outsourcing solutions for the second year in a row that was judged in five main categories: size and growth, customer references, awards and certifications, programs for innovation, and corporate social responsibility.

It extends GeBBS’ long history of awards.  Modern Healthcare has listed us as one of the nation’s top 15 largest revenue-cycle management companies for 2016 and we’ve been recognized as one of the top 20 outsourcing providers for revenue cycle management for hospitals 100 beds and up, according to Black Book Market Research.

As hospitals are forced to do more with less, outsourcing provides the scale necessary to optimize revenue from complex claims collections to end-to-end revenue cycle management. Be sure to select an outsourcing partner that fully understands your healthcare RCM needs.

Tags: Business Process Outsourcing (BPO), Revenue Cycle Management (RCM), Offshore Medical Billing, Offshore Medical Coding, Outsource Coding, outsourced coding, outsourced medical billing, Offshore Revenue Cycle Management, coding outsourcing, RCM Solutions

Streamline Your Revenue Cycle Management

Posted on Tue, Jun 28, 2016 @ 05:00 AM

In their May 6, 2016 newsletter, the AMA stated that: “Patient care is the top priority and a source of passion for physicians, but making sure the business side of your practice is ‘healthy’ also can contribute to better outcomes and patient satisfaction.”

We couldn’t agree more!

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This has been GeBBS Healthcare Solutions’ philosophy from day one. If your practice does not have a “healthy” operating margin, you cannot have a patient care mission.

For physicians, getting paid properly for the services they provide is extremely important. Between constantly changing coding rules and dozens of insurance contracts -- each with its own coverage, billing and payment terms -- many medical practices find it difficult to keep up. As a result, physicians are too often paid less than they actually should be, which impacts their cash flow.

Following are six ways to streamline your revenue cycle and maintain your practice with a “healthy” margin to provide the best patient care possible:

  1. Pre Visit
    1. Timely Prior Authorizations
    2. Accurate Insurance and Benefit Verification
  2. Post Visit
    1. Medical Coding
    2. Timely and Effective Charge Capture
    3. Payment/Denial Posting
    4. Accounts Receivable Management

The good news is that you don’t have to take on these tasks by yourself. If you engage an experienced RCM outsourcing partner, you can accomplish all of these crucial functions promptly and efficiently, even though you may have a small internal staff. An outsourcing partner will more than pay for itself by significantly increasing your practice’s insurance payments.

Few words arouse more frustration among physicians than “pre- authorization.” And it’s easy to understand why. The time physicians have to spend persuading an insurance company to cover a medication or procedure is an expensive and annoying distraction from the task of caring for patients.

Practices with more than one location can create greater efficiencies often by centralizing the prior authorization responsibility. Putting just dedicated individuals in charge of prior authorizations for the entire practice will enable those employees to become highly skilled in the process and develop relationships with the payers.

GeBBS' centralized “Prior Auths” team effectively utilizes payer website access, and phone calls to maintain a stringent turnaround time, saving precious time and money for the practice.

With the Affordable Care Act coming into effect, the volume of self pay has been steadily increasing. The absence of proper insurance and benefit verification is the number one contributor to higher self pay balances downstream. GeBBS provides effective insurance eligibility verification services with the objective of educating patients of their copay and deductibles. GeBBS can go one step forward and collect the payments ahead of the appointment, by accepting credit card and other payment options. This drives higher patient satisfaction.

We also offer high quality coding services to assist in preventing inadequate documentation or coding errors (one of the primary reasons physicians fail to get paid appropriately for their services) by providing highly-trained, certified coders. Our team is comprised of experienced Certified Professional Coders (CPCs) accredited by the American Academy of Professional Coders (AAPC) and Certified Coding Specialists (CCSs) accredited by the American Health Information Management Association (AHIMA).

Proper charge capture enables physicians to create superbills anywhere, anytime, on their PCs, tablets, or smart phones. As the charges are captured as per the system-installed CPT and ICD-10 codes, our services ensure greater accuracy, reduced chance of missed charges, and quicker initiation of the billing process. GeBBS has experience in working with all the leading practice management systems and EMRs.

Accurately recording and managing the vast amount of information associated with patient care—from account creation to payment posting—requires specialized skills and innovative technologies. GeBBS' expert data capture services are driven by our proprietary workflow application engine. This solution automates the receipt, processing and posting of all RCM paper documents including charges, demographics, insurance payments, patient payments, and correspondence.

Our A/R follow-up solutions can lower internal costs, increase collections, and improve your cash flow. GeBBS' expert analysts trend denials and look for patterns of deficiency that will increase your cash flow and reduce aging A/R. We specialize in enhancing the financial performance of our clients by seamlessly supporting end-to-end revenue cycle management and its related processes.

We provide access to a scalable and large pool of resources experienced in multiple practice management systems to increase your collections ratio.  Our sophisticated A/R workflow tool seamlessly performs skill-based routing. It also generates customized intelligent reports that help quickly identify and resolve unpaid accounts. Our skilled staff is trained to identify patient accounts that require follow-up and take the necessary action to collect unpaid/underpaid claims.

Tags: Business Process Outsourcing (BPO), Revenue Cycle Management (RCM), Offshore Medical Billing, Medical Billing BPO, outsourced medical billing

End-to-End Revenue Cycle Management Will Keep You Out of the News

Posted on Tue, May 31, 2016 @ 12:40 PM

A large Chicago-based health system recently posted an operating loss of about $186 million in 2015, nearly 15 times the amount reported in the previous year. In addition, the system will lay off 250 employees and leave 450 jobs unfilled. The health system has told its bondholders that it will write off $53 million of its accounts receivable for patient bills that went uncollected, according to a major Chicago newspaper. The CEO has attributed almost half of the system's financial losses to an inadequate collections system, which forced the hospital to write off some bills for being too old to collect.

This did not have to happen!

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If the health system had implemented an end-to-end, comprehensive revenue cycle management (RCM) solution that includes payer credentialing and a complete billing and collection service, they could have avoided their financial quagmire. An all-inclusive RCM solution would have helped them stay on top of their Medicaid and Medicare billing, managed care plans, government-funded programs, and third-party insurances. They would have had available to them key performance metrics for accounts receivable and collections to measure their ongoing success and integrate best practices, where and when needed.

Following are just a few of the RCM solutions that could have helped this health system avoid their financial challenges.

Successfully scheduling patient flow takes thought and careful planning. It is by far one of the most challenging aspects of care delivery, but when done properly, managing patients’ schedules will increase your capacity and efficiency without increasing your overhead.

In today’s healthcare environment, especially with the Affordable Care Act, insurance and eligibility verification are absolutely critical. Identifying patient responsibility upfront prior to services rendered is critical to managing receivables. In the absence of proper eligibility and benefit verification, countless downstream problems are created — delayed payments, reworks, decreased patient satisfaction, increased errors, and nonpayment.

Accurate charge data entry – entering the correct patient demographics and financial information into the billing and coding systems system are also critical. In addition, validation of procedure codes to documentation and CPT/ICD coding will help avoid downstream collection problems.

Daily insurance claim submissions with claim edit corrections and reconciliation of all claims will provide an immediate boost to your revenue cycle and keep it healthy over the long run.

Proactive accounts receivable management is a must! This includes monitoring the status of all accounts and aged receivables with ongoing denial management and credit balance resolution for all applicable accounts.

And finally, outbound and inbound phone center support which includes soft collection calls, pre-bad debt management calls, self-pay patient calls, incoming billing inquiries, patient updates/payments and statement production for improved collections.

If this health system had an RCM solution, in place, like the one just described, we would not be reading about them in the newspaper.

Tags: Business Process Outsourcing (BPO), Revenue Cycle Management (RCM), Offshore Medical Billing, Medical Billing BPO, outsourced medical billing

CMS and AHIP Move to Improve Healthcare Quality Measures

Posted on Thu, Apr 28, 2016 @ 04:00 AM

The Obama administration and health insurers took steps recently to standardize and improve the measures that are intended to gauge the quality of healthcare. The CMS and trade group America's Health Insurance Plans (AHIP) have announced an agreement to adopt a core set of quality measures for the nation's doctors. Officials say the measures are necessary as payers and consumers bear more responsibility for finding and purchasing high-quality care and providers are increasingly paid under contracts tied to their quality performance. This is a good move!

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Nobody benefits when doctors spend time collecting different data for multiple insurers instead of using those resources to improve the quality of patient care. This agreement to standardize quality measures can accelerate development of capturing data that patients care about most – how fast they recover from any illness or treatment.

The most important aspect of this new quality program will be how it deploys superb clinical documentation and expert medical coders to identify and codify these new quality measures.

Medical coding is the lifeblood of a revenue cycle, regardless of whether or not it is used in pay-for-performance contracts. Accurate and efficient coding is crucial to meet financial and compliance goals. Medical coding can be complex yet time sensitive, where being down even a single coder can impact revenue. Healthcare providers need reliable medical coders who are accurate, productive, and experts in all types of inpatient and outpatient coding.

An expert HIM company can provide immediate, experienced coding professionals to help healthcare providers capture these new quality measures. Whether the medical coders work on-site or remote, U.S. or global, their knowledge and training is top notch. They know the most current coding regulations and keep up to date with the latest in patient care in the clinical and hospital setting. Strict enforcement of coding compliance guidelines, ongoing reviews, and a commitment to continuing education promotes coding accuracy, data integrity, and proper claims submission.

These new quality measures are also making accurate clinical documentation more important than ever. RAC, Medical Necessity, ICD-10, pay-for-performance, and the growth in volumes resulting from the ACA are all impacting healthcare organizations. The ability to get reimbursed is directly dependent on the quality of clinical documentation. Missing, poor, or non-specific clinical documentation will result in lost revenue.

Outsourcing can help you comply with the new quality measures and get you paid faster by improving your clinical documentation. Outsourced CDI specialists are professionals of the highest caliber. They are credentialed, experienced, and they are passionate about getting even the smallest details right. Whether the CDI professionals are assessing your program or supplementing your staff, they can help you develop, improve, and maintain your clinical documentation to meet the new CMS and AHIP quality measures.

Tags: Business Process Outsourcing (BPO), HIPAA, Medical Coding, Offshore Medical Coding, Outsource Coding, Medical Coding BPO

The Climb to Conquer “Mount ICD-10” Is Going to Get Steeper

Posted on Mon, Mar 28, 2016 @ 05:00 AM

The climb to conquer Mount ICD-10 is going to get steeper and more difficult. Be sure you have an experienced guide to help you on this perilous journey. The ICD-10 transition difficulties were lessened by CMS by not dropping all of the thousands of new codes on the healthcare industry at one time. That is going to change.

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The Centers for Medicare & Medicaid Services (CMS) recently added for review about 1,900 diagnosis codes and 3,651 hospital inpatient procedure codes to the ICD-10 coding system for healthcare claims in fiscal year 2017. The large number of new codes is due to a partial freeze on updates to the ICD-10-CM and ICD-10 PCS codes prior to implementation of ICD-10 on Oct. 1, 2015. The new diagnosis codes are included in the hospital inpatient prospective payment system proposed rule for FY 2017.

There is time to get prepared for onslaught of these new codes. Begin your search for an outsourcing partner who has the expertise to lead your facility on this journey and ensure your revenue cycle is not impacted.

While patient volumes are on the rise with the newly insured, your ability for achieving patient satisfaction, profitability, and compliance goals are increasingly at risk. A robust Health Information Management (HIM) program has never been more critical to the success of healthcare organizations than it is now.

This is precisely the time to engage with a partner who brings a deep understanding of the revenue cycle. An experienced outsourcing partner can help you cut through the complexity of the new ICD-10 codes with expertise, operational excellence, and a sophisticated technology approach.

An experienced outsourcing partner can offer a comprehensive range of HIM solutions that will help you comply with these new codes using a diverse portfolio of services, including:

Make sure your facility has an “experienced Sherpa” to help you master the climb to the pinnacle of “Mount ICD-10.”

Tags: Business Process Outsourcing (BPO), HIPAA, Outsource Coding, Medical Coding BPO

There Is NO Substitute for Training & Experience When It Comes to HIPAA Compliance

Posted on Tue, Mar 22, 2016 @ 10:20 AM

By Nitin Thakor, GeBBS President & CEO

The HHS Office for Civil Rights (OCR) recently imposed heavy monetary fines and acceptance of resolution agreements and corrective action plans on two provider organizations following substantial violations of the HIPAA privacy and security rules.

About 30 organizations to date have now agreed to such sanctions after OCR determined they were essentially ignoring HIPAA.

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This action reinforces the importance for healthcare providers to deal with experienced vendors and outsource organizations when it comes to HIPAA compliance. There is no substitute for intense training on how to handle protected health information (PHI). PHI touches almost every aspect of healthcare delivery from revenue cycle management to patient care, and healthcare providers must ensure they are dealing with a partner that completely understands all aspects of HIPAA compliance.

Whether it’s an HIM solution, end-to-end revenue cycle management, insurance billing, or a patient access solution, the company applying these applications to help healthcare providers must understand, and more importantly, apply ALL HIPAA compliance regulations as they use these solutions in the actual delivery of healthcare. Training and experience are the key factors in delivering on HIPAA compliance.

An experienced outsource company will have in place a business associate agreement (BAA) that addresses risk analysis and all potential vulnerabilities to a client’s electronic protected health information. They will examine where and how their solutions impact PHI and address its protection enterprise-wide throughout the client’s IT infrastructure.

When it comes to PHI and HIPAA compliance, training and experience do make a big difference.

Tags: Business Process Outsourcing (BPO), HIPAA, Medical Coding BPO

CMS Chronic Care Management (CCM) Initiative Can Help Improve Bottom Line for Physicians

Posted on Fri, Mar 18, 2016 @ 05:00 AM

In today’s healthcare delivery environment, physicians are constantly looking for new ways to earn and increase their bottom lines. For example, the 2015 Medicare Physician Fee Schedule (PFS) will pay for non-face-to-face services for CPT code 99490 -- Chronic Care Management (CCM), which reimburses practices on an average of $42 per patient, per month. Of all the governmental mandates that have come along -- this is a good one. It incentivizes physicians to extend their care management and care coordination services to their patients who need it the most, and it will improve outcomes for critically-ill patients.

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The good news is that chronic care management, as well as the medical coding for these services, can be fulfilled by professional outsourced companies. This is a critical element of the CMS initiative.

Traditionally, physicians have not had the staff bandwidth to support intensive Chronic Care Management; however, this initiative allows doctors to outsource much of the hands-on, daily care coordination to healthcare organizations who are staffed with experienced care management and medical coding professionals. These outsourced coding companies can work hand in hand with a medical practice’s CCM to provide end-to-end professional services. 

It’s not a coincidence that more than 80% of practices who want to offer CCM services to their patients ultimately end up outsourcing their CCM service and their medical coding. 

The billing physicians are still responsible for creating their critically-ill patients’ care plans and directing the efforts of their professional outsourced staff. 

CMS allows physicians who bill for the 99490 code to delegate this non-face-to-face time, and provide only general supervision on the CCM work they do. This critical change allows physicians with smaller professional staffs to extend the medical coding and care management of chronic diseases to their patients who need it the most and at the same time create a new revenue stream.

Tags: Business Process Outsourcing (BPO), Offshore Medical Billing, Offshore Medical Coding, Outsource Coding, outsourced medical coding, outsourced medical billing, Offshore Revenue Cycle Management, coding outsourcing, Medical Coding Outsourcing, Remote Medical Coding, Medical Coding BPO

Medical Coding Outsourcing is More Than Staffing

Posted on Thu, Feb 18, 2016 @ 06:00 AM

Outsourced medical coding's traditional approach has been staff augmentation. It has been typically used to meet short-term gap needs due to turnover, extended absences, or electronic medical record (EMR) changes. In other words, it has been used when a healthcare provider needed temporary additional resources to supplement its existing resources. However, from our experience, this traditional staff augmentation model is not keeping up with the rapidly changing needs in the healthcare industry.

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There is a growing demand for healthcare services to meet the needs of an aging population and the burgeoning impact from newly-insured patients resulting from the Affordable Care Act. The effect is a trickle down that has increased staffing needs all along the revenue cycle from coding to accounts receivables to collections. With the industry’s transition to ICD-10 with its new codes and processes, and computer-assisted coding (CAC), providers have been challenged to keep up with this evolution.  There is a need for coders -- not just new coders, but also current coders who have been trained to work in today's new coding world.

As a result, there are some healthcare providers who have spread their outsourcing needs across multiple vendors to meet this demand. Invariable, the quality can suffer with inconsistencies among different vendor processes and management. Further, the vendor has limited economic incentive to make meaningful investments to ensure success due to the limited or unknown contract length. Short-term traditional approach engagements face ramp-up challenges, since even experienced coders may need 45 or more days to reach full efficiency. Coders working in these environments may not capitalize on the values of synergy in processes and technology that using outsourcing professionals from a single vendor offers.  

GeBBS, which was recently selected to this year's IAOP Global 100 Outsourcing List, has seen this trend with its long-term investment and delivery of end-to-end revenue cycle management (RCM) solutions. These solutions provide not only coders, but also HIM technology platforms for coding and audits to improve coding efficiency, accuracy and control. This combination of coders and a comprehensive audit and management capability creates transparency for higher coding performance that meets client standards. The byproduct from higher coding performance is the reduced number of claim denials, which ultimately improves the provider’s revenue flow.  This long-term investment is just as true with accounts receivable and patient access, where the strength of GeBBS’ outsourced RCM is not just outsourcing staffing, but also the infrastructure backbone supporting the staffing. The net impact that healthcare providers are seeing include cohesive outsourcing benefits across all of the elements of people, processes and technology.  So when you think of outsourcing, realize the important value that outsourcing can provide is not only people, but also the processes and technology to support those people.

Tags: Business Process Outsourcing (BPO), Offshore Medical Billing, Offshore Medical Coding, Outsource Coding, outsourced medical coding, outsourced medical billing, Offshore Revenue Cycle Management, coding outsourcing, Medical Coding Outsourcing, Remote Medical Coding, Medical Coding BPO, Coding Accuracy

Big Data and 2016

Posted on Tue, Jan 26, 2016 @ 06:00 AM

Since the inception of the term “big data,” how to handle this data has been a challenge for healthcare providers. Big data has been around since computers were first harnessed to help the healthcare industry. The challenge has always been how to handle and make sense of this copious amount of information. In 2016, big data will continue to grow. Healthcare providers will have to develop an infrastructure, or scale up through outsourcing, the capabilities to use this big data to their best advantage. You can expect an increase in the use of relationship algorithms that formulate inferences, allowing decisions to be made in real-time.

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For big data to be effective, you need to provide the right tools to the right people in the right ways. The better healthcare providers understand the varying needs of their end users, the better they will be served by the big data they own.

A huge amount of data is being generated that needs to be part of the patient record and the hospital’s revenue cycle. This data needs to be available across the entire continuum of care.

Adoption and success in big data analytics is never going to happen overnight, certainly not by the end of 2016. For one thing, most healthcare organizations need help in the adoption and use of data analytics tools -- from revenue cycle improvement to medical coding.

If you want to improve your use of big data in 2016, consider outsourcing to scale up your infrastructure immediately. An experienced outsourced provider can offer in-depth healthcare industry expertise to help you use your big data to provide end-to-end solutions to successfully resolve your billing and medical coding challenges. Outsourcing can deliver, immediately, a world-class infrastructure of highly skilled professionals, robust processes, and proprietary workflow engines. This makes for an ideal partner to help you with your big data challenges and reduce operating and capital costs, recover revenue, improve patient satisfaction, and increase productivity.

Tags: Business Process Outsourcing (BPO), Clinical Documentation Improvement (CDI)

Grow Your Own Doctors

Posted on Tue, Jan 19, 2016 @ 11:30 AM

By Nitin Thakor, GeBBS President & CEO

The U.S. does have a physician shortage today and that shortage is expected to grow to over 130,000 by 2025. What is causing the problem? In my opinion two things are driving this shortfall of doctors. First, millions of new patients are and will be entering the healthcare delivery system under the Affordable Care Act (ACA). One of the main tenets of ACA -- and it is not a bad thing -- is its focus on the prevention of developing medical problems, not treating medical conditions; this takes significant time and resources.

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The second problem with the doctor shortage is that primary care physicians (PCPs) are slowing becoming extinct. Fewer medical students are choosing primary care as their career path. Older PCPs are retiring early. Many others are closing their practices or seeking employment with large health systems and hospital. Today only 30 percent of all physicians practice primary care -- compared to about 70 percent in most other developed countries.

Kaiser Permanente is solving their physician shortage by opening a medical school in Southern California with its first class expected to enroll in the fall of 2019. They intend to grown their own doctors! According to Kaiser’s press announcement: “they intend to instill Kaiser’s integrated model for high-quality care at sustainable costs in the minds of future physicians.”

By training physicians in their system's care model, well before residency, the school will better prepare doctors for work within their system, which could boost Kaiser's population health metrics, improve efficiency and drive down costs when graduates are hired down the road.

The concept of training your own professionals to fill shortages is not new. Consider the U.S. at the beginning of the 20th century when trained school teachers were almost nonexistent. Normal colleges burgeoned in practically every state to educate teachers for the growing U.S. population.

Dr. Edward Ellison, a national leader for Kaiser and an executive sponsor for the school, summed up the school’s philosophy. He explained, “We have a rich history in teaching physicians. This is the missing piece of the arch. We need to prepare physicians for the way health care will be delivered in the future, not just medicine, but about integrated systems of care and how to work in a much different medical environment. Our advantage is we can start from scratch.”

Kaiser is doing just that; they will prepare physicians to meet their growing medical needs who are also schooled in their health system’s care delivery philosophy.

Tags: Business Process Outsourcing (BPO)