Providers are facing real challenges as we enter the 2020s, and headwinds are everywhere. Changing and expanding requirements from government entities and insurance companies, new payment models, and revenue cycle management (RCM) issues like rising bad debt and uncollectible amounts leave hospitals providers searching for a way forward.
One solution that is receiving widespread interest from CFOs and IT professionals is partnering with third-party RCM teams. With more and more regulatory changes and guideline fluctuations, more and more providers are seeing the benefits of teaming up with an experienced and versatile third-party billing partner who can scale up or down according to system needs.
Where Can Improvements be Expected?
Providers and physician groups are often hesitant to relinquish control when it comes to something as important as RCM. However, locating and hiring a partner that has the latest technology and expertly trained specialists goes a long way in providing peace of mind.
Consider these areas where efficiencies can be gained when outsourcing AR improvements:
- Increased revenue with teams using state of the art automation and best practices when handling all aspects of billing. From coding to billing to insurance discovery, a third-party partner brings a focused clarity to collecting your revenue.
- Significantly decreased operating costs in the form of reduced staffing costs, supplies, real estate, not to mention capital acquisition costs for equipment and software.
- Reduced overall staffing costs, including all costs associated with hiring and recruitment, onboarding, managing, and training people for the RCM function.
- With improved automation comes better security—a third-party partner will be merging with the provider’s EMR through an integrated HL-7 or API bi-directional interface, allowing an exchange of data through secure transmission.
- An upgraded prior authorizations (PA) software solution that performs most PAs in real-time using automation and artificial intelligence (AI)-driven software, that allows vastly improved scheduling of patient procedures or tests and accurate collections for patients’ portion due, while significantly reducing denied claims.
- Virtual elimination of medical coding and billing errors without having to maintain an internal team of certified, trained coders. ICD-10 coding continues to grow in complexity, and what’s needed is comprehensive decision making with lightning speed and complete accuracy, something a third-party partner would provide.
- Increased billing proficiency with guaranteed accuracy and improved collections. From accurate keying to spot-on coding, clean claims submitted quickly ensure timely reimbursement and reduced denials.
- Automation-leveraged insurance discovery that finds new revenue from unidentified insurance coverage either not disclosed by the patient or unknown at the time of care.
- And last, but by no means least, highly improved patient engagement and satisfaction rates, reduced surprise billings, and an overall enhanced perception by the community.
Providers today are faced with receding revenue and increasing expense costs addressing everything from staffing and recruitment to supplies. These aren’t new obstacles, but they seem to be ever more emergent as value-based payments and provider shortages add additional pressure. Engaging a third-party RCM partner to facilitate AR improvements for hospitals seems a worthwhile consideration as we head into a new decade.
Contact us to learn how partnering with a third-party team can ease the RCM process by reducing costs and capturing additional revenue.