Streamlining Revenue Cycle Management (RCM) and collecting the maximum reimbursement for the orthopedic services your practice provides is an operational goal that deserves serious thought. Practices often hesitate in making this change because they fear a decrease in operational efficiencies and a loss of control in their bottom line performance.
With a Revenue Cycle Management (RCM) partner, your organization can swiftly and successfully move through the healthcare payment lifecycle. A well-managed transition ensures practice operations continue to progress smoothly and improved results are recognized in record time.
Benefits Provided by an RCM Partner for Orthopedic Practices
Today’s industry-leading RCM partners bring the latest technology combining artificial intelligence (AI) and machine learning, coupled with the skill and mastery of certified specialists, to provide a level of service that is unmatched. If you have taken steps to ensure the upfront patient access functions have been handled error-free, including prior authorization and insurance and benefit verification, then an RCM partner can deftly handle the payment lifecycle, including coding, billing and claims submission, denials management, and the final collection phase.
Between surgical procedures and in-office visits, RCM for orthopedic practices is complex and ever-changing. Here are functions that an RCM team can absorb:
—Effective medical coding requires a strong understanding of medical documentation and how regulatory rules guide the coder to derive compliant ICD-10 and CPT codes from the medical record for appropriate reimbursement. With current industry error rates averaging well over 5%, utilizing an RCM partner employing systems and staff with exemplary coding credentials would help reduce this rate significantly and thereby capture additional, previously lost revenue.
Medical Billing and Charge Entry
—Once a patient has been seen, time is of the essence to submit clean, accurate and complete claims to the appropriate insurance payer. By partnering with an RCM team of experts with scalable resources, this process is compliantly expedited with full charge capture. Additionally, any recommended operational improvements can be implemented to reduce future errors and claim denials.
Payment Posting and Accounts Receivable (A/R)
—To fully optimize revenue reimbursement, payments need to be posted in real-time and further action determined and initiated at the earliest point in the A/R process. If additional amounts due are to be billed for secondary insurance or patient responsibility, it is crucial to submit those claims or statements as soon as possible.
Further, methodical follow up on outstanding A/R ensures timely collection of revenue decreasing Days Outstanding and the amount of A/R that slips into uncollectible territory. With trained partners shepherding your billing through the collection process, your practice will enjoy reduced write-offs for uncollectible bad debt.
—Claim denials have always been accepted as a necessary pain arising during the billing process, but what if you could reduce the time and energy your practice is spending managing the entire process? With an RCM partner that deploys an automated denial management solution that leverages artificial intelligence and machine learning, denials can be drastically reduced as patterns are recognized and evaluated, and operational adjustments recommended.
The RCM landscape is ever-changing and evolving with new and updated guidelines or mandates that are frequently published by governmental and private payers. The ability to keep pace with these regulatory challenges is only half the battle. The other half is as monumental—ensuring that staff members are current and proficient with the latest RCM changes.
By partnering with an RCM organization, you lessen the need for in-depth expertise and are able to shift those resources to providing the highest level of care and an outstanding patient experience. Our changing healthcare reimbursement environment brings opportunities to revisit orthopedic billing practices and operations and those improvements can be reflected in your bottom line results.
Contact us to learn how the right RCM partner can benefit your orthopedic practice today.