GeBBS Healthcare 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.

GlobalOutsourcing100-2017-24-24.png

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

Be Prepared for "Surprise" Medical Billing

Posted on Wed, Feb 08, 2017 @ 12:45 PM

A recent article on the Radiology Business Management Association (RBMA) web site discussed consumer’s frustration with the cost of medical care as being at an all-time high as many purchasers of narrow-network, high-deductible and high-co-pay health plans are finding out that the benefits they get from their monthly insurance premiums are much more limited than they thought. One target of their frustration is “surprise” medical bills for services such as radiology, as well as other medical specialty services that a patient may receive from an out-of-network (OON) physician, while either receiving emergency care or a planned treatment at an in-network facility. It is an issue that has been covered by the likes of Consumer Reports and numerous other publications in recent years.  In response, state legislators in nearly two dozen states are either considering or have already passed laws to protect patients from such unexpected/surprise bills.

CRO_Health_CROH_July_Medical_Bill_05-15.png

Both California and New York have passed “Surprise” Medical Billing laws. The California Law applies to plans and insurance policies issued in California, amended, or renewed after July 1, 2017.

It is important for providers, health plans, and insurers in California to quickly create a plan to successfully navigate this new law. It is also important to note that these new California and New York regulations may be harbingers of laws elsewhere as it represents the next step in the evolution of state legislative efforts to address the tricky issues that arise when beneficiaries receiving OON services without a reasonable opportunity to consent to them.

This is precisely the time to engage with a partner who brings a deep understanding of the revenue cycle and provides tailored insurance billing solutions that cut through the complexity with expertise, operational excellence, and a sophisticated approach. An expert outsourced billing partner can deliver solutions specific to each client’s need, while working with a client’s host system and using its tools to build efficient workflow processes with higher output through the use of a hybrid of automated and manual solutions.

The healthcare environment is changing with these new “surprise” medical billing laws, The Affordable Care Act and whatever evolution may follow, and the transition to ICD-10 all put added layers of expense and complexity on our already burdened billing systems.  Patient volumes are on the rise with the newly-insured population, and high-deductible plans putting added pressures on revenue cycle operations and the drive to collect payments. 

The key to success is access to a large pool of outsourced, qualified denial management experts who can work in any healthcare environment and that understand the new compliance laws, such as “surprise billing,” and how to quickly and correctly analyze account history, appeal denied claims, and get timely turnaround to recover on and close out A/R.  Outsourced RCM analysts adept at trending denials and looking for patterns of deficiency will increase cash flow and reduce aging A/R.

Tags: Revenue Cycle Management (RCM), RCM Solutions, Patient Access Management, Medical Billing BPO, Offshore Medical Billing, outsourced medical billing

High Deductible Self-Pay Accounts Can Be a Major Threat to Revenue Cycle Management

Posted on Thu, Jan 26, 2017 @ 05:00 AM

According to data from the latest quarterly Crowe RCA Benchmarking Analysis: "Patient Financial Responsibility on the Rise,” healthcare providers could be facing a major threat to their revenue cycles. The analysis found that in the past year, insured patient financial responsibility has grown from 23.3 percent to 26.9 percent for outpatients and 10.2 percent to 12.1 percent for inpatients.

Threats.jpg

This new revenue cycle threat comes from the fact that patients continue to take on more financial responsibility for their care due to participating in high-deductible health plans, especially those of the Affordable Care Act, (ACA). In 2017, the out-of-pocket maximum for ACA can range from $7,150 for an individual plan to $14,300 for a family plan before marketplace subsidies kick in. Healthcare providers are struggling with collection rates as they try to adapt to increasing patient responsibility amounts for insured self-pay co-pays and deductibles, according to the Crowe benchmarking data.

This trend is expected to grow over the next few years. As a result, both patient liability and bad debt are on the rise and healthcare providers are experiencing unprecedented revenue and margin pressure. Hospitals and clinics have become like retail organizations, which need to provide their consumers with access to payment capabilities at point of service, via the web, through payment plans, and more. The answer for healthcare providers is to take advantage of professional outsourcing companies who have expertise in patient access management solutions that can improve patient satisfaction, while lowering your collection costs and increasing revenue.  These necessary outsourcing services include:

- Scheduling, Eligibility Verification, and Pre-Authorization
- Patient Call Center
- Self-Pay Collections

Self-pay collection is the most critical of these services. A recent McKinsey study found that 74 percent of insured consumers indicated that they are both able and willing to pay their out-of-pocket medical expenses up to $1,000 per year and 90 percent would pay for medical expenses up to $500 per year.

Reasons for a rise in self-pay bad debts are due in part to inefficient and ineffective collection practices followed by most billing companies and physician practices. An expert self-pay collections team uses technology-enabled practices to maximize patient contact with:

  • - Easy to understand patient statements
  • - Automated dialers
  • - Digital messaging campaigns
  • - Mobile technology to drive text messaging campaigns

The outsourced self-pay collections team leverages analytics to arrive at the best time to contact patients and their propensity to pay scores to create outbound campaigns that are patient experience-oriented, non-obtrusive, and drive higher patient connect ratios.

Don’t let high-deductible, self-pay insurance amounts wreck your revenue cycle. Work with an experienced outsourcing team that will provide your patients with flexible payment options and easy access to payment capabilities for web, phone, credit card, and e-check payments.

Tags: Revenue Cycle Management (RCM), RCM Solutions, Patient Access Management

Specificity of ICD-10 Coding Can Improve Reimbursements for Vaccine Administration

Posted on Wed, Jan 11, 2017 @ 10:15 AM

Administration of vaccines is an important part of healthcare delivery, and a critical contribution to preventive public healthcare. However, risings costs are making it difficult to align vaccine administration expenses with revenues.

There may be some relief to these rising costs and it comes from something that was once seen as a burden for medical practices. That relief comes in the form of ICD-10 coding.

MMRvaccine.png

The transition to ICD-10 was seen as an administrative burden for many practices, but it does offer some relief in aligning vaccination reimbursement with actual costs. Compared to the previous coding system, ICD-10 recognizes the type of vaccine provided by the CPT or HCPCS code entered, negating the need for individual diagnosis codes.

The American Academy of Family Physicians (AAFP) offers specific coding guidance for practice billing patients covered by Medicare Part B and Medicare Part D. The Centers for Medicare & Medicaid Services (CMS) also offers guidance on choosing the right code for adult vaccinations, including the seasonal flu shot.

Correct coding is essential to receiving the proper reimbursements. A robust Health Information Management (HIM) coding program has never been more critical to the success of healthcare organizations than it is now. If your practice is not sure whether or not you have the expertise to code properly and receive the optimum reimbursements you deserve, it’s time to engage with a partner who brings a deep understanding of how proper coding affects the revenue cycle.

GeBBS Healthcare Solutions provides Health Information Management (HIM) solutions that cut through the complexity with expertise, operational excellence, and a sophisticated approach. We are a leading provider of outsourced medical coding and coding validation audits, and we have a unique insight into your challenges when it comes to data quality and coding accuracy, productivity, and reliability.

Let our team of expertly trained and qualified Health Information Management coders, who adhere to the best practices in the HIM coding field, make sure you receive the optimum reimbursements for your vaccine administrations.

Tags: Revenue Cycle Management (RCM), RCM Solutions, ICD-10, Medical Coding, Medical Coding BPO, coding outsourcing, outsourced coding, outsourced medical coding

AHA President and CEO Asks President-Elect Trump For "Steady as She Goes" Effort on Healthcare

Posted on Tue, Dec 20, 2016 @ 11:00 AM

By Nitin Thakor, GeBBS President & CEO

AHA President and CEO Rick Pollack recently sent a congratulatory letter to President-elect Donald Trump and asking him to go slowly on changes to our healthcare delivery system, particularly when it comes to the Affordable Care Act (ACA). This is good advice since healthcare represents a significant portion of the U.S. economy and essential public services. Pollack explained his case in terms that abrupt changes could lead to significant instability for patients, providers, insurers and others.

health_care_in_usa_icon_pg_3.jpg

However, he was not so cautious when it came to Stage 3 Meaningful Use and M&A mergers. Pollack urged the President-elect to cancel Stage 3 of Meaningful Use, standardize the M&A merger review process, and reform the RAC program.

Pollack's letter highlighted five areas of concern for hospitals: reducing the regulatory burden; enhancing affordability and value; continuing to promote quality and patient safety; ensuring access to care and coverage; and continuing to advance healthcare system transformation and innovation.

In my opinion, much of what Mr. Pollack asked for makes perfect sense. It is my sincere hope that President-elect Trump will understand the consequences of abrupt changes to any financial system. He has already softened his stance on cancelling ACA on Day One of his administration. There are many things wrong with the ACA and reform is needed. I am hopeful that thoughtful men and women of goodwill will come up with a new plan that includes more participation of the private sector and the ability to sell health insurance across state lines.

This will provide a replacement plan that continues to provide a mechanism for individuals to obtain affordable insurance coverage, with realistic deductible amounts. Everyone who works in healthcare knows that the regulatory burdens faced by hospitals and physicians are substantial and unsustainable.

I remain hopeful that thoughtful reform can be accomplished, and we look forward to working within this new healthcare delivery system.

Tags: Revenue Cycle Management (RCM), Revenue Cycle Solutions, RCM Solutions, Medical Billing BPO, Healthcare Revenue Billing, Insurance Billing Solutions, Best Practices

Beware of Secondary Injury to Your Wallet after an ER Visit

Posted on Tue, Dec 13, 2016 @ 03:00 PM

A recent article in US News and World Reportexplained a little known fact of which most patients are completely unaware. A trip to the emergency room could cause a secondary injury to a patient’s wallet. Even if a patient goes to a hospital included in his or her health insurance network, if the emergency room physician who treats the patient is not part of the health insurance network, the patient will be responsible for a separate and unexpected bill.

ER2.jpg

Is this a big problem?

Research conducted by Yale University found that roughly 2 of 10 in-network visits involved a doctor not in the patient's insurance network. Going to an in-network hospital does not mean all your charges will be covered.

There is some slight hope in these situations. If you are attended by an out-of-network doctor, it doesn't necessarily mean financial calamity. That can depend, in part, on the patient's insurance coverage. And, some states like New York have laws that offer some protection against surprise bills, although the extent of that protection varies.

There are limited options to rectify the unexpected charges. Patients can ask that the claim be processed again as in-network care since the patient had no way of knowing the doctor was out of network or they can try to negotiate a lower bill.

In recent years, especially since the creation of the Affordable Care Act's public insurance exchanges, insurers have formed networks of doctors and hospitals, in part, to gain some leverage for negotiating reimbursements.

When the medical treatment is an emergency situation, you don’t always have time to question the physician’s insurance network coverage. However, if you have time, it’s a good thing to make sure your attending physician is part of your health network.

Tags: Revenue Cycle Management (RCM), Revenue Cycle Solutions, RCM Solutions, Medical Billing BPO, Healthcare Revenue Billing, Insurance Billing Solutions

The Importance of Revenue Cycle Management in an Evolving Healthcare Delivery Environment

Posted on Tue, Dec 06, 2016 @ 06:00 AM

At the recent Becker's Hospital Review 5th Annual CEO + CFO Roundtable healthcare experts seasoned in the revenue cycle management (RCM) process discussed how their organizations and companies are working to stay ahead of the financial curve.  As hospitals evolve into a value-based care delivery environment, RCM becomes even more critical.

arrows_centered.png

The Roundtable highlighted the fact that hospitals are striving to cut costs and that has paved the way for revenue cycle management to come center stage, with organizations throughout the nation making it a top priority. Each year, the United States spends $2.7 trillion on healthcare. Of that figure, $400 billion goes toward claims processing, payments, RCM management and bad debt, a 2009 McKinley & Co. study found. Additionally, the study also found 15 cents of every U.S. healthcare dollar goes toward revenue cycle efficiencies.

As patients become increasingly responsible for their healthcare dollars and margins get tighter due to shrinking reimbursements, the need for an end-to-end RCM process reaches a critical tipping point.

An end-to-end revenue cycle management process must be comprehensive and include everything from payor credentialing to complete billing and collections services. One of the Roundtable participants, a large healthcare system, had tried using an outside software solution, but allowed each member hospital to apply the solution in its own manner. They achieved only mixed results.

An experienced outsource provider of RCM solutions will have the management expertise in all facets of the revenue cycle and knowledgeable people to provide and manage an all-inclusive solution. Their billing experts will be well versed in all Medicaid state plans, managed care plans, government-funded programs, third-party insurance, and Medicare billing rules. They will also have the expertise to follow industry-standard key performance metrics and integrate best practices, so you will achieve the RCM results you desire.

An effective, end-to-end RCM outsourced solution will also include an HIM management component. This will provide an in-depth innovative solution that will allow you to successfully resolve your RCM challenges, while enhancing your overall business operations. A well-qualified outsource company will form a partnership with your hospital to optimize your RCM processes by leveraging their people, processes and technology to ensure your success.

Tags: Revenue Cycle Management (RCM), Revenue Cycle Solutions, Offshore Revenue Cycle Management, RCM Solutions, Health Information Management (HIM)

How to Survive in a Value-Based Healthcare Delivery Environment

Posted on Thu, Oct 06, 2016 @ 11:00 AM

Black Book™, well-known for its accurate, impartial customer satisfaction surveys in the services and software industries, recently conducted its annual revenue cycle management outsourcing and software/technology user poll. They survey the clients of RCM vendors to provide insight into their customer experience in the functional areas of Billing, Charge Capture, Mid Process Coding, Claims Management, Reimbursement, Insurance and Payer Management, Payment Resolution and Collections, and collectively for end-to-end RCM software/technology and outsourced managed services.

Black_Book_Rankings_Seal-2016-GeBBS.png

Black Book’s most recent survey found that RCM solutions are in current replacement mode or assessment by 85% of provider organizations, hospitals and physician practices. The reason for this surge is that providers are trying to cope with the impacts of a value-based healthcare delivery environment. Healthcare providers are seeking to optimize their fiscal operating environments with better RCM solutions to improve payer connectivity, using advanced analytics that enhance the patient experience. 94% of health organization CFOs surveyed believe transformed revenue cycle management processes will allow them to become more efficient and positively impact their organization’s financial health.

If your organization has not embraced an end-to-end revenue cycle management solution that includes everything from payor credentialing to complete billing and collections services, you need to do so immediately to cope with the effects of the new value-based healthcare delivery system.

A comprehensive, business process outsourcing (BPO) company can provide RCM solutions that will provide expertise in multi-specialty collections and billing to deliver an all-inclusive RCM solution with billing experts that are well versed in all Medicaid state plans, managed care plans, government-funded programs, third-party insurance, and Medicare billing rules. They will be able to follow industry-standard key performance metrics to measure success and integrate best practices, so that you get the full value of proven experience and expertise.

A comprehensive RCM package should include:

System and Process Implementation -- PMS/EMR Implementation (optional); development of provider dictionaries, chargemaster(s), procedure code dictionaries, and clearinghouse set up.
Scheduling, Eligibility Verification, and Pre-Authorization -- Patient schedules reconciliation, eligibility verification and pre-authorization/pre-certification, including copay/co-insurance estimates.
Data Entry -- Patient demographic and financial information; charge entry into PM system; coding and billing edits.
Full Range of Certified HIM Clinical Medical Coding Services -- Validation of procedure codes to documentation and accurate PT/ICD coding that are ICD-10 ready, along with coding compliance audits.
Claims Submission -- Daily file submission; claim edit correction; reconciliation of claims.
Accounts Receivable (A/R) Management -- Status, aged receivables projects and ongoing denial management; credit balance resolution.
Customer/Patient Access Solutions -- Outbound and inbound phone center – make soft collection calls; pre-bad debt management; self-pay patient calls; incoming inquiries, patient updates and payments; and statement production (DMA).

GeBBS Healthcare Solutions, a leading offshore RCM provider, has just been named for the third year in a row to Black Book™ Market Research’s list of the top 20 outsourced revenue cycle management services. We can help you survive in the new value-based healthcare delivery world.

Tags: Revenue Cycle Management (RCM), Offshore Revenue Cycle Management, RCM Solutions, Revenue Cycle 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!

RevenueCycleManagement.png

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!

Revenue Cycle Management - Performance Objective

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