Since the Healthcare industry is constantly evolving, it can be difficult to keep up with the latest RCM developments. Here are five emerging trends around healthcare Revenue Cycle Management to keep an eye on in 2022:

• The Use of Artificial Intelligence & Machine Learning in RCM

One of the most prominent emerging trends in RCM is artificial intelligence (AI) and machine learning (ML). These cutting-edge technologies are being utilized more and more to help streamline the medical billing process and improve overall efficiency. For example, AI can automatically identify errors in claims so they can be corrected before they’re submitted. This can save valuable time and money down the line.

• The Shift to Value-Based Care

Value-based care is another trend gaining traction in recent years. Under this model, providers are paid based on the quality of care rather than the number of services rendered. This shift has put a greater emphasis on preventive care and population health management. As a result, Revenue Cycle Management has had to adapt to this new paradigm.

• The Rise of Patient Financial Responsibility

With the rising cost of healthcare, patients are shouldering a more significant financial burden than ever before. This trend has led to increased patient out-of-pocket financial responsibility including deductibles, copays, and coinsurance. As a result, Revenue Cycle Management must now place a greater emphasis on collecting these payments from patients. Therefore, medical billing teams are focusing on working more closely with patients to set up payment plans and collect outstanding balances.

• The Need for Greater Transparency

Due to the rising costs, patients are demanding greater transparency from their healthcare providers. They want a clear understanding of the cost of their care upfront in order to compare prices between different providers. Providers must be honest about their pricing, and provide patients with clear and concise bills, giving a complete breakdown of all charges.

• The Importance of Data Analytics

Data analytics is playing an increasingly important role in Revenue Cycle Management. Medical billing professionals can identify areas in need of improvements by analyzing data. For example, data analytics can be used to determine which claims are being denied and why, it can also be used to track trends over time and identify potential problems down the road. This information can improve the claims submission process resulting in fewer denials and increase the bottom line.

By staying up to date on the latest medical billing practices and Revenue Cycle Management strategies, you can ensure that your organization runs as efficiently as possible. If you’re looking for a medical billing solution that can help you stay ahead of the curve, iPatientCare offers a complete suite of Revenue Cycle Management servicesthat can be tailored to meet your organization’s unique needs.

iPatientCare offers end-to-end Revenue Cycle Management (RCM) services to hospitals and physician practices. We provide complete ownership of your medical billing and Revenue Cycle, from Patient Engagement to Payment Posting, so you can focus on what’s important – providing quality patient care. Our team of medical billers has the knowledge and experience to help you navigate the ever-changing landscape of Revenue Cycle Management.

Contact us today to learn more about how we can help you improve your Revenue Cycle Management strategy.

What are CPT Codes?

CPT codes, also known as service codes, are five-digit numeric and alphanumeric modifiers that identify each task or service a healthcare provider offers. These codes are used by both providers and payers to communicate services rendered, billed, and paid for. The first four digits identify the specific procedure or task that was carried out while the fifth digit, an alphabetic modifier, identifies if there were any additional services provided in connection with this code. CPT codes have helped reduce billing-related disputes between healthcare providers and payers by providing a common ground for understanding the service that was provided.

As an example, CPT Code 80233 – minor office/outpatient visit includes history and examination while CPT Code 80233 with modifier -25 (office/outpatient visit for evaluation and management of a new patient) signifies a new patient who has not been seen by any other physician at this practice or elsewhere.

Types of CPT Codes:

• Category I: codes assigned to medical procedures, services, devices, and drugs, including vaccines.

• Category II: codes enabling performance measures and quality of care.

• Category III: temporary CPT codes used for new or emerging technologies, services, and procedures.

• PLA codes: recently added to the CPT code set describing proprietary clinical laboratory analyses and testing.

How to Find a CPT Code?

American Medical Association’s (AMA) website provides an online search tool for CPT codes. Inputting the list of services provided prompts the tool to deliver the CPT code for that service. CPT codes are updated every year by the American Medical Association (AMA) in collaboration with other medical specialty societies. The updates help reflect changes in technology, services, and procedures that have taken place over the past year.

Alternatively, Electronic Health Record (EHR) software has the ability to select appropriate CPT codes when billing patients. EHRs have drop-down menus that list all the CPT codes and their descriptions for each service offered by a provider.

It is also recommended to hire professional medical coders or coding services to correctly bill for services rendered. Medical coders use CPT, HCPCS Level II, and ICD-CM codes to assign codes correctly.

How to Submit the CPT Code?

If your office staff is using paper forms, then the CPT codebook must be used to find the right code. If your practice utilizes an EHR, such as iPatientCare, then the software should automatically populate the CPT codes as you type in descriptors of each service on the visit note screen. Always review all the information before submission. It is important to note that the billing process may vary from one healthcare setting to another.

Submission: Healthcare providers or staff generally submit the medical documentation to the coding staff at the billing service. They review the documentation, assign CPT and other codes, and forward the claim to the appropriate insurance company.

Verification: The insurance company reviews the claim and responses, which is called remittance advice. The advice informs the provider of what services are covered, the amount that will be paid, and other information related to the payment of the claim.

Claim Processing: Once the verification is confirmed, the insurance company will process the claim and initiate the payment process.

Preventing Incorrect Coding

CPT coding is a complex process that requires experienced medical coders. It is vital to stay up to date with the latest CPT codes and changes to ensure a smooth billing process. Take the time to review each bill carefully and compare it to your medical records. If you find any discrepancies, don’t hesitate to reach out to the billing department and ask for an explanation.

Common mistakes include:

• Incorrectly billing a service
• Incorrect CPT code entry
• Including incorrect modifier
• Billing for services not rendered
• Filing a claim before all documentation is received
• Not verifying that the coder understands how to bill your services correctly

Medical billing is a complex process; iPatientCare offers a comprehensive and user-friendly EHR and Revenue Cycle Management solution that can help your practice streamline its coding and billing process. Our team manages all aspects of provider billing from claim submission to denial management. If you are interested in boosting your practice’s revenue and reducing denials contact us today.

A clinically driven revenue cycle is a holistic approach to Revenue Cycle Management (RCM) Services that focuses on patient care throughout the entire healthcare process. This approach is beneficial to both the patient and the healthcare organization as it ensures that the best possible care is being delivered while also maximizing revenue. It is the combination of clinical expertise and RCM in which the collection of clinical data is used to make informed decisions about claims to proactively identify issues and potential denials before claims submission.

Implementing a Clinically Driven Revenue Cycle

Adopting a clinically driven revenue cycle is more than an IT implementation it involves changing the way care is delivered within the culture of an organization.

• Organizational Alignment: It is essential that physicians, nurses, clinical staff, and revenue cycle staff are all aligned with the clinically driven revenue cycle approach. This will ensure that everyone is working together toward the common goal of providing high-quality patient care while maximizing revenue.
• Technology: Proper training and use of technology is critical to automate tasks, improve communication and coordination among staff, and provide real-time insights into key performance indicators.
• Processes: Standardized processes are necessary to ensure that all staff members are using the same procedures and protocols when interacting with patients and processing their information. Staff must be properly trained on best practices.

Related Article: Increase Revenue Cycle Management Efficiency with These Four Steps

Benefits of a Clinically Driven Revenue Cycle

A clinically driven revenue cycle is not a one-time implementation but rather an ongoing approach to RCM that should be regularly evaluated to ensure the organization remains aligned with current clinical best practices. A clinically driven revenue cycle will result in:

• Improve Patient Care: The focus on patient care throughout the entire cycle helps ensure that patients receive high-quality, coordinated care that is more efficient and effective. By improving care and reducing complications, patients can achieve quicker positive health outcomes or require less expensive interventions on continued treatment. Patient-centric care improves overall satisfaction, which can result in higher referral and retention rates.
• Improve Efficiency: A clinically driven revenue cycle streamlines processes and eliminates redundancies, improving patient care.The ability to document clinical care in a more concise and structured manner can help reduce the time needed to complete documentation, improve communication among staff, and support better patient outcomes.Real-time reporting capabilities allow for better insights into key performance indicators that lead to improved decision-making within your organization.
• Boost Revenue: With better care delivery, healthcare organizations can expect an increase in revenue as patients are treated more effectively. Boosting clinical outcomes while reducing claim denials allows organizations to grow their bottom line  especially when the expenses associated with RCM (e.g., call center costs, billing errors, etc.) are taken into account.
• Reduce Denials: Healthcare organizations can expect a decrease in denials as all aspects of the revenue cycle are aligned with clinical best practices – from eligibility and insurance verification to coding and billing.
• Reduce Costs: By automating repetitive tasks where possible, healthcare providers can spend less time on non-value-added activities and focus on higher-value work that improves patient care.
• Improve Compliance: A clinically driven revenue cycle can assist with compliance as it provides staff members with the tools they need to address patient care, coding, billing, and reimbursement requirements.

For a healthcare organization, adopting the clinically driven revenue cycle is a win-win situation. It’s a collaborative effort between the revenue cycle and clinical staff that requires commitment from everyone within the organization.

iPatientCare provides Revenue Cycle Management for providers across the United States. Our team manages all aspects of provider billing from claim submission to denial management. If you are interested in boosting your practice’s revenue and reducing denials contact us today to learn more about the benefits of a clinically driven revenue cycle.

Below are a few essential RCM services to improve your practice

1.ELIGIBILITY VERIFICATION:

Eligibility verification is the process of ensuring a patient is eligible for benefits under their insurance plan. The RCM team can also check for disability coverage if it applies. RCM services can help you verify patient eligibility by checking benefit plans against your billing codes and procedures. This helps reduce the amount of denied claims and ultimately improves your cash flow.

2. CLAIMS SUBMISSION:

Claims submission is the process of submitting claims after services have been rendered. The RCM team ensures that the claim is submitted as cleanly as possible prior to submission to help maximize reimbursement potential.

3. TIMELY CLAIMS PROCESSING:

RCM services streamline payments by automating the submission process with electronic claim submissions and follow-ups via fax or mail if needed in a timely manner. This improves cash flow with quicker and more accurate claims.

Timely claims processing is imperative to receive the maximum reimbursement. If your claims are submitted too late, insurance companies may deny them causing your practice to resubmit it at a higher cost.

4. CODE AUDITING:

Code auditing validates medical codes against procedure documentation to determine accurate reimbursement levels from payers such as Medicare, Medicaid, commercial carriers, and workers’ compensation companies.

RCM service providers offer code validation solutions designed specifically around healthcare workflow processes. Often, they can provide real-time updates on risks involved with each provider and/or their staff. An audit could be required for a variety of reasons such as:

• Accreditation survey
• Medicare compliance review
• Third-party payer contract negotiations
• Revenue cycle improvement initiative

RCM services can support a code audit by providing expert resources; this helps ensure your practice is billing for procedures accurately and maximizing reimbursement levels.

5. PAYMENT POSTING:

Payment posting accurately tracks your revenue and expenses by submitting payments from patients and insurance companies to the correct accounts within your practice’s accounting system. RCM services automate payment posting so it is completed quickly and efficiently. Automating this process keeps your practice’s financial data accurate and up to date.

6. DENIAL MANGEMENT:

Denial management is the process of following up on unpaid or denied claims. RCM services can help your practice track claim status, prepare appeals, and negotiate with insurance companies. This decreases the amount of lost revenue within your practice.

7. COLLECTIONS:

The collections process consists of pursuing collections from patients who have received care but have not yet paid their bills This can be a daunting task. RCM services track patient balances and contact those patients who are overdue on their payments. This helps reduce bad debt for your practice and improve your cash flow.

Outsourcing these RCM services can help improve your cash flow, automate administrative tasks, and keep your practice compliant with insurance companies, Medicare/Medicaid guidelines, and more. Investing in a robust RCM service is vital to the success of any healthcare organization.

iPatientCare is one of the top healthcare Revenue Cycle Management services providers in the United States. Our team manages all aspects of provider billing. From claim submission to denial management, our healthcare RCM services experts know the importance of a seamless revenue cycle.

Contact our Revenue Cycle Management experts today to learn more about how iPatientCare can benefit your practice.

According to Trends in Healthcare Payments – Annual Report, the average medical practice writes off over $30,000 in unpaid medical bills each year. 28% of the practitioners have no idea how much they are or should be writing off. As healthcare reimbursement evolves, healthcare providers must adapt and start focusing on increasing payments and decreasing A/R time in order to increase cash flow and collection at their practice.

Increase cash flow and collection at your medical practice by implementing these four simple steps.

1. Follow efficient insurance verification process
2. Send pending invoices at regular time intervals
3. Offer multiple payment options
4. Outsource your revenue cycle management process to a trusted partner

1. Follow efficient insurance verification process prior to offering service

The first step in this process is to ensure that each patient has valid, active insurance coverage before they receive any care. A simple way to do this is through software tools integrated with your electronic health record (EHR) system that can do quick insurance checks.

2. Send pending invoice at regular time intervals

Sending a copy of the bill to the patient’s insurance company after each visit, will significantly shorten A/R over time. Additionally, asking patients to pay their bills as they leave can also increase revenue flow. The most common reason for not receiving payment from insurance companies is incorrect or lack of information from your office. By reducing the number of outstanding claims, you also reduce the amount of reimbursement they can deny and increase cash flow and collection in medical billing.

3. Offer multiple payment options

Offering multiple ways for your patients to pay is one of the easiest steps you can take to improve cash flow and collection. By offering credit card payments, checks, cash, etc., you broaden the options for your patients. Taking it one step further, sending electronic statements via email or text messages attached with these payment options or online payment links, makes payment simple and fast. Additionally, offering payment plans adds an extra layer of convenience by allowing patients to take control of their healthcare costs.

Offering payment assistance programs will also improve cash flow and collection within your medical practice. This option is quickly gaining popularity across all industries. Position yourself for success by providing information on your website about financial relief options.

5. Outsource your Revenue Cycle Management process to trusted partner

Outsourcing your Revenue Cycle Management (RCM) process is the best way to transition your medical billing processes in-house and improve cash flow and collection for your business. By partnering with a qualified RCM company to take care of all aspects of your A/R process, including accounts receivable and collections, you will be able to save money on labor costs while increasing customer satisfaction due to faster payments and reduced A/R time.

Taking some of these simple steps, can greatly reduce outstanding claims and collection issues, while quick improving cash flow. Efficient Revenue Cycle Management is key to successful revenue generation. With a qualified workforce, checkpoints at each stage of the claim processing, and regular audits, you can build an efficient and effective RCM process for your practice.

If you are interested in learning more about iPatientCare’s advanced RCM solutions, contact our experts today.

RCM is a comprehensive process that requires a specific skill set and bandwidth for handling various scopes of services at different levels by different staff. Efficiency and effectiveness are key determinants to process quality claims and improve revenue flow.

The RCM process can be classified into three key segments for self-assessment:

1. Personnel

• Do you measure the quality and productivity of your team?
• Does your staff provide comprehensive demographic, insurance, and clinical documentation to support accurate billing?

2. Process

• Are procedures in place for workflow documentation?
• Does your billing team have a smooth, effective process for claims submission and payment posting, including reviewing errors and denials?

3. Tools & Technology

• Have you implemented up-to-date and effective tools and technology for your practice, such as an Electronic Health Record and Practice Management System?

Improve your practice’s revenue cycle with these four steps:

1. Perform Regular Claim Audits

Unfortunately, claims denials are unavoidable. However, they can be reduced by having checkpoints in place at each step along the life cycle of the claim. This can help identify the reason(s) for repetitive errors so your team can determine patterns for errors and work to fix them.

2. Reduce Batch Size to Achieve Higher Efficiency

The volume of claims at each stage affects the efficiency of the RCM process. Using the smallest batch size per day may achieve higher efficiency and process claims in a shorter time frame. Smaller batch sizes might also allow the billing team to have more visibility into potential errors and may improve efficiency in fixing them.

3. Utilize monthly reports

As a business entity, it is crucial to monitor your growth trends, loopholes, percentage of submitted claims, and paid and denied claims. Conducting a monthly review of paid claims against the claim volume affords a clear indicator of efficient Revenue Cycle Management. Your Practice Management System should have a robust reporting library to help provide insights into areas of improvement and current revenue status.

4. Partner with an Experienced Billing Service

To reduce financial stress, outsourcing your RCM to a billing partner may be the best solution for your practice. iPatientCare’s Revenue Cycle Management team can manage the entire billing cycle from start to finish.

Efficient Revenue Cycle Management is key to successful revenue generation. With a qualified workforce, checkpoints at each stage of the claim processing, and regular audits, you can build an efficient and effective Revenue Cycle Management process for your practice. If you are interested in partnering with iPatientCare’s advanced RCM solutions, contact our experts today.

Here are 3 steps to help you manage claims denials at your medical practice and start receiving timely reimbursements.

1. Ensure that all patient demographic and insurance information is entered into the EHR accurately.

Correctly capturing patients’ demographic and insurance information is the first step to successfully billing claims and avoiding denials. Insurance companies will check this information against their records during the claims reimbursement process and may deny claims if demographic or insurance information is incorrect. Train front desk staff and registrar personnel on how to capture and enter this information as accurately as possible.

2. Obtain prior authorizations when required by insurance carriers.

Insurance payers often require prior authorization for high-value services and drugs. Obtaining this prior authorization information from the carrier prior to billing the claim will help ensure that the claim has all of the information it needs to be paid and will reduce the chances of a claim denial. Implementing a streamlined process among your billing team to obtain prior authorizations is an important consideration to manage prior authorizations.

3. Proactively identify and review denials.
   

Implementing a process to proactively identify and work denials is critical in the denial management process. Request that a member of your billing team run denials reports and check claims statuses frequently to ensure denials are worked and resubmitted in a timely manner. It is important to make sure denials are worked quickly so payments can be received as fast as possible for maximum reimbursement.

There are a number of steps you can take to reduce claims denials and get paid for the services your practice renders. iPatientCare’s efficient billing workflow makes it easier to identify and work denials to maximize reimbursement potential for practices. Our expert revenue cycle management team is also available to manage all aspects of billing, including denial management and follow-up.

If you would like to see how iPatientCare’s Practice Management software and or Revenue Cycle Management services can help your medical practice schedule a demo or contact us today.

Key features include:

• Scheduling  appointments
• Checking into appointments
• Conducting a clinical telehealth visits
• Conducting post-visit work such as electronically prescribing medications
• Checking out of appointments and reviewing & signing visit notes

Scheduling appointments

New or current patients are able to request virtual appointments in just a few clicks when using a telehealth solution. Patients can view their provider’s availability and select  a time that works best for them.

Checking into appointments

Once the visit is scheduled on the telemedicine platform, patients can join either through a link in their email or via a text message. Clicking on the link just prior to the appointment takes patients to a virtual waiting room where front desk staff guide them through the virtual visit.

Conducting clinical telehealth visits

Once a clinical note has been started and the pre-consultation requisites have been concluded, the provider is ready to interact with the patient. During the course of the consultation, the provider can upload relevant files, share educational links with the patient, and share their screen when necessary. An electronic health record (EHR) mobile application workflow allows providers to check clinical content, set schedules, capture screens, and access e-prescriptions.

Concluding the visit

After the provider updates his/her status to “Ready to Check-out”, the EHR application prepares for the last step of the online consultation. The provider may prompt their patient to make payments, send additional resources, or provide a summary of the session.

Getting started

Want to stay ahead of the curve? Implement a robust telemedicine program that meets the needs of your practice. Click here to schedule a live demo of digital healthcare solutions provided by iPatientCare.

These are the major needs geriatric populations require for adoption of telehealth service.

Ease of use

Senior patients need a portal that is both easy to understand and use for complete adoption of telehealth solutions. If they don’t feel secure and comfortable their trust in the technology will quickly diminish.

Level of usefulness

Typically, older generations stick with solutions they comfortable with. Educating this population of the benefits of mobile healthcare can go along way to gaining trust and changing behaviors.

Computer Anxiety

Elderly patients are more inclined towards in-person healthcare and have some negative responses towards computers and other tech devices. They feel anxious about using mobile phones & computers due to a lack of experience, knowledge, & problems related to usability and accessibility.

Providers Recommendations

Physician’s recommendation to use telehealth plays a very important role in its acceptance in an elderly population.

Telehealth is not just helpful to senior patients; the technology is also helpful for the family and caregivers. The following are some of the conditions for which telehealth can be utilized and managed in the treatment of elderly patients.

Chronic Care Management

Telehealth is highly suitable for the homecare clinicians, to keep track and monitor the patient with chronic health issues. They can keep regular check on patients’ vitals, treatment outcomes, doctor’s diagnosis, and patient’s response to provide accurate help to the patients.

Care for Cardiac Patients

Clinicians can regularly keep in touch with doctors to track patient’s health who have undergone recent heart failure or surgery. They can coordinate care on proper food, timely medications, rest, and manage stress levels.

Care for Immobile Patients

Elderly patients who face issues with mobility due to illnesses like, arthritis, paralysis, muscle stiffness, joint pain, and aftercare for accident cases can also be taken care of with telehealth services.

Range of Telehealth Apps for Seniors

• GPS tracker
• Panic Alert
• Pain monitors
• Diabetes monitor
• Medication tracker
• Fall detector
• Depression tracker

Adopting telehealth not only reduces the number of patient visits in hospital settings, but it is also beneficial for patients and hospitals to save on some extra expense associated with healthcare. Gradual awareness among the people and continuous efforts taken by the healthcare centers will increase the adoption of telehealth technology.

Knowing the financial challenges within rural healthcare setting, here are four RCM myths we commonly see impacting revenue.

Myth 1: Patients don’t contribute much to the payer mix

With the increasing financial responsibility of healthcare costs, patients are now the third-largest payer in the country. A large portion of the rural population is more likely to be uninsured (particularly in states that did not expand Medicaid). Therefore, rural clinics and healthcare facilities need to provide accurate clinical estimations and upfront fee collections before delivering care. Since patients are becoming more aware of their healthcare costs, price transparency is becoming increasingly important. Providing upfront clinical estimations at the point of service or procedure can help improve healthcare bills and reduce bad debt and write-offs.

Myth 2: Patient engagement has nothing to do with revenue

Patient engagement involves more than simply talking to patients or sending them emails and messages. Patient engagement encompasses everything from patient management to revenue management. Using clinical facilities can reduce missed appointments with appointment reminders, deploy CCM programs for reimbursement by CMS, receive payments electronically using patient portals. Patient engagement helps providers administer better care delivery, which drives the revenue.

Myth 3: Telehealth doesn’t pay off 

Medicare and Medicaid have made it easy for clinicians to find lists of covered telehealth services by CPT code and reimbursement guidelines on their web portals. The reimbursement for telehealth is the same as that of a face-to-face visit, although some commercial payers may differ. Most importantly clinicians need to have eligibility and proper credentialing with payers and be licensed in the state(s) they expect to treat patients. Providing telehealth not only drives new revenue streams to the rural clinic, but also provides a more convenient care delivery method for patients who need it most.

Myth 4: Outsourcing in RCM technology is a dead investment

This is not the case. Rural clinics and hospitals can get full reimbursements of their revenue by outsourcing their complete RCM process. With today’s technology, it is much easier for hospital back offices to keep track of key performance indicators such as accounts receivable, claims filed, and EDI rejection rates. By integrating finances with patient portals that offer electronic payment options, sending electronic statements and automated reminders to patients, and enabling patients to pre-pay for the services, back offices can ensure everything that their RCM partner needs. All of this resultss in stronger reimbursement and strengthening of cash flow that makes ROI on the technology and services investment measurable.

Rural hospital facilities have led and will continue to lead their communities with resilience, innovation, and collaborative partnerships. We believe that experienced healthcare leaders understand their requirements for success. We embrace the truth of today’s rural, patient, and RCM landscapes.

iPatientCare, is a leading provider in transforming RCM services with FREE Cloud-based Meaningful Use Stage-3 certified EHR and PMS technology. It provides efficient, responsive, and accountable billing implementation and back-office services that give more than 98% first-pass claims submission and efficient AR follow-up, denial management at very competitive rates. To learn more visit iPatientCare’s Healthcare Revenue Cycle Management.