All the practices are looking for quick returns with complete avoidance of denials. The only way this is possible is by either out-sourcing to a reputed billing company or by having a perfect in-house biller.
Quality of Work Analysis
| Scope of Work | In-House | Outsourced |
| Regular Work-flow | The absence of a biller even for one day can make a sharp decline in productivity and financial health of the practice | You have a team of qualified RCM professionals who are trained and work in collaboration as backup and provide you with almost a 24*7 environment and culture |
| Overheads | Your overheads increase when you are hiring an in-house biller, you have to pay an hourly wage, paid vacation, taxes, health insurance, etc. | Pay us as per the contractual terms, NO Extra charges involved until you add any new service to the existing one |
| Staffing | Your billing suffers if any one of your billers quits or is unable to work due to any unforeseen reasons | You don’t face such issues at all while working with a team |
| Proximity | You have a face time with your biller and your biller gains your trust being working and delivering in front of you | You have an account manager who is not only available for you for fixed hours but is available on-demand, just like calling 911 |
| Dead Collections/lost AR | The possibility of missed encounter forms, unappealed claim denials, rejections, incorrect billing are more as you have one person only to handle everything single-handed | Contractually obliged to perform your complete billing process such as appealing, denials, rejections at a certain level and we have a team of experts who have expertise in specific areas such as the A/R team, Denial Management team, Charge Posting Team, etc. |
| Best Practice Standards | Biller is limited to the knowledge they have at the time of joining you, afterwards they get occupied with the day-to-day billing work. In order to stay updated with best-practice standards, the current insurance world, and changes in the healthcare billing industry you may have to shell out from your own pocket. | Dedicated Team of certified billers that are working on your account and are being simultaneously undergoing continuous training programs from time to time, and attends webinars and seminars to stay indulged with the latest industry trends |
| Revenue Enhancement | Biller being handicapped with current knowledge or limited knowledge may not be able to help you out in collecting on what is potentially known as hidden revenue potentials such as taxes, interest, withhold, deferred payments, incentives, billing codes as per provider rightful and medical records | Our Billing team is trained and qualified to maximize your revenue by killing such constraints and empower you with a profitable business while you stay focused on providing patient care |
The decision by a healthcare practitioner about outsourcing or having an in-house biller is faced by every practice sooner or later as the practice grows. It is in the best interest of practice to outsource and improve the cash flow, instead of investing time and money on billing headaches.
Today’s revenue cycle processes are quite complex. With the assistance of a professional medical billing company, there is guaranteed economic success and compliance with many government regulations. Billing is no longer something that any staff member can do when they have time between patients. The disputes of the internal billing operations can lead to collection shortfalls and non-compliance issues. That is why outsourcing to a professional Practice Management/Billing company makes sense.
The medical practice management software is used to streamline major tasks in your organization. It saves time when checking on patients’ insurance eligibility and scheduling appointments. It reduces the effort involved in managing denied claims and in generating reports. PMS easily integrates with an EHR system. It easily helps to set up new patient records and to add information.
The main features of PMS that assist in generating revenues:
- Claim denial manager and electronic claim submission
- Captures patient demographics
- Management and financial reporting
- Scheduler
- ICD-10 coding converter
- Insurance eligibility verification
- Maintains insurance payer lists
- Financial reporting & benchmarking – the premium source that lets you compare your financial performance with other practices.
How does PMS help in Revenue Cycle Management?
Paper-based systems are ineffective and medical practices should make the switch to the practice management software. Billing errors impact the revenue of the practice. Therefore revenue cycle management runs smoothly with help of Practice Management software.
This software speeds up the exchange of information as the claims are submitted. It also discovers why a claim was denied and then fixes it and returns the updated information to the insurance provider. PMS easily schedules patients and cuts down waiting time at the reception.
Sufficiently documenting treatment plans reduces claim denials and facilitates faster reimbursement. Managing compliance limits audit risks, fraud, and improves predictive budgeting and forecasting. The prompt communication improves patient satisfaction, enabling data collection, and has the potential to improve patient outcomes. This billing and collections give administrators more control over workflow patterns and financial stability.
Why is Revenue Cycle Management important in Healthcare Industry?
The compatible and coordinated systems provide the increased functionality that is required today. The biggest advantage of an integrated system is the ability to offer almost everything needed to manage the billing and scheduling using a single vendor. By combining the two systems, the challenges many independent practitioners face becomes easier to manage. This can lead to more quality time for the patients. Also, there will be greater efficiency at the front desk and administration.
At the end of the day, all practices are seeking the same thing – increased revenue and decreased costs. Healthcare revenue cycle management service is the key to staying out of all billing hassles. While each office has its own unique billing needs, consistency in a few areas can boost revenues. The right practice management system is the key to achieving the potential efficiencies offered by electronic transactions and workflows. Practice Management System and Revenue Cycle Management go hand in hand. Both complement each other.
