If you trained to be a doctor, why are you spending time worrying about payments? Maybe it’s time to Hire a Revenue Cycle Management Company.
By: Steven Collins and Pat Kroken
Professional Revenue Cycle Management (or “RCM”) frees physicians from the worry of how they’ll be paid and allows them to focus on taking care of patients.
What is Revenue Cycle Management exactly?
Whether the care being delivered is a simple office visit or a complex treatment program involving a number of healthcare providers and facilities, each initiates a process where a bill is generated and sent for payment (a “revenue cycle”).
The revenue cycle involves multiple steps that need to be done correctly to secure accurate payment for medical services. Managing the revenue cycle (“Revenue Cycle Management”) is about developing, implementing and overseeing a consistent process to deliver payments to providers in a timely and accurate way, whilst navigating through the complexity of payer rules and patient contacts to secure those payments. And persisting in the RCM process to bring to resolution any legitimate charges where for some reason payment is disputed or denied. That’s what Revenue Cycle Management is, exactly.
What are the steps associated with Revenue Cycle Management?
There are many steps involved in RCM. These may differ depending on the type of medical care being delivered, but generally include:
– Every medical service (such as an office visit or an MRI) must be charged for and recorded (or “captured”), and a bill prepared.
– A unique code is used for each medical service, and the correct code must be applied for a charge to be paid. This is a specialized task. The codes can be complex and imprecise coding can result in inaccurate (or denied) payment. RCM companies employ highly trained coding specialists.
– Bills (or claims for payment) are prepared and submitted to government health programs like Medicare and Medicaid, to healthcare insurance companies, to patients, and other payers. Most claims are submitted electronically (although patients may receive a paper bill).
– If a bill has been properly prepared (the right service, the proper provider, the correct medical code) and is submitted for payment it is usually paid in a timely manner (this is referred to as a “clean” claim).
– Various forms of payment are received from payers, patients, and government programs. All payments must be kept secure to avoid fraud and directed appropriately by the RCM company to appropriate provider bank accounts.
Denials follow-up and management
– Payers may reject, or question claims for a host of reasons. Such “denied” claims need to be tracked and pursued by the RCM company, corrections made, and appeals submitted to the payers to justify payment.
It makes sense, but what are the benefits of hiring a Revenue Cycle Management Company?
Dependable, consistent revenue is a must for every healthcare organization, and while many groups have their own in-house billing resources, increasing overhead and maintaining top talent are common issues.
Outsourcing the billing function to a revenue cycle management company usually results in lower costs while maintaining effectiveness – and offers the advantage of employing RCM experts in your healthcare specialty (because there are differences in how each specialty is billed).
A successful Revenue Cycle Management company offers:
- Faster claims submission and cash flow turnaround
- Access to coding expertise and experience—so you get paid for the work you do
- Updated technology and intelligent automation resulting in increased payments
- Depth in billing expertise and claims follow-up
Increase Productivity and Success with Revenue Cycle Technology
Radiologists handle a high volume of studies so it’s essential to have in place technology for effective management of the revenue cycle. Many practices struggle with the cost of technology and expertise required to maintain a top-flight billing system.
MSN Healthcare Solutions uses the most widely-used, designed-for-purpose radiology billing system and consistently invests in the IT talent and supporting software options to maximize the effectiveness of its billing operations:
- Staff use efficient worklists to track and follow-up on both unpaid claims and denials
- Regular monthly reports present data to track metrics, trends and variances. In addition, flexible custom reporting supports data-driven decision making.
- The RCM technology gives ready insight into the billing cycle, so MSN managers work with real-time information
- Client practices have stronger compliance with federal and state regulations
The ever-changing healthcare environment means even greater complexity for revenue cycle management.
Steven Collins, Vice President, Client Relationships, & Business Development
Steve brings a varied radiology background to MSN clients, with 27 years’ experience working with radiology groups in different capacities. He has been an operations manager for a large private practice group serving multiple hospitals and imaging centers and also developed and implemented business expansion opportunities for a consortium of leading radiology practices.
In addition, Steve has successfully worked in sales for both revenue cycle management companies as well as market-leading radiology practice management and radiology information systems. He has been involved with the Radiology Business Management Association (RBMA) as a member of the Board of Directors for the national organization as well as revitalizing the Colorado RBMA chapter and serving as its President.
Patricia Kroken, FACMPE, CRA, FRBMA,
has an extensive background in radiology practice management and directs education and corporate communications for MSN Healthcare Solutions.
She worked as a consultant for radiology practices, billing companies, software developers, and hospital radiology departments for 20 years before joining MSN.
She is a regular contributor to the RBMA Bulletin and a frequent speaker on topics related to radiology practice management.
Pat can be reached at firstname.lastname@example.org