8 Step Approach Every Third Party Billing Company Must Follow

 Erika Regulsky Medical Billing, RCM

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Before hiring a third party billing company you should check whether they follow the 8 Step Approach

Efficient revenue cycle management (RCM) is crucial for healthcare organizations to maintain financial stability and optimize operations. Third party billing companies play a pivotal role in streamlining billing processes and maximizing revenue. In this blog post, we will explore the key steps involved in improving RCM while highlighting the benefits of collaborating with expert revenue optimization consultants. Additionally, we will delve into the advantages of leveraging Robotic Process Automation (RPA), the importance of transparent Service Level Agreements (SLAs), RCM restructuring, denial and Accounts Receivable (AR) management, coding management, and the critical phase of transitioning new claims with third party billing healthcare.

Step 1: Lost Revenue Audit 

A crucial step in evaluating the financial health of a healthcare organization is conducting a Lost Revenue Audit. This comprehensive analysis involves evaluating collection rates, write-offs, bad debts, and revenue gaps. It helps identify areas of revenue leakage, allowing for the recovery of lost revenue from existing accounts receivable. With the assistance of reliable 3rd party medical billing companies, organizations can bridge these gaps effectively.

Step 2: Expert Revenue Optimization Consultants

Collaborating with third party billing healthcare revenue optimization consultants brings valuable expertise and insights to maximize revenue and improve financial performance. These consultants analyze revenue streams, identify inefficiencies, and offer tailored solutions. By assessing key metrics such as costs, pricing structures, and revenue gaps, they develop customized strategies and implement revenue management systems. Healthcare organizations can leverage the expertise of third party billing companies that work closely with revenue optimization consultants to enhance decision-making, adaptability, and revenue growth.

Step 3: Robotic Process Automation (RPA) 

The implementation of Robotic Process Automation (RPA) in healthcare RCM processes offers numerous benefits. RPA ensures uninterrupted operations as automated bots work continuously, unaffected by sickness or vacation time. These bots adapt and improve over time, learning from changing workflows. By automating manual data processes, RPA significantly reduces operating costs, eliminates errors in patient data, and improves clean claim ratios. Streamlining manual processes with the help of 3rd party medical billing companies allows RPA bots to complete RCM tasks in a fraction of the time, enhancing productivity and efficiency.

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Step 4: Transparent Service Level Agreements (SLAs)

Transparent SLAs are essential for healthcare organizations when partnering with 3rd party medical billing companies. These agreements outline the terms and expectations, ensuring clarity and accountability. Key metrics such as claims processing time, denial rate, collections, and response time are specified in SLAs. They establish a mutual understanding of performance benchmarks and foster effective collaboration between the healthcare organization and the 3rd party medical billing company. Transparent SLAs enable healthcare organizations to monitor billing service performance closely, identify areas of improvement, and address issues promptly.

Step 5: RCM Restructuring 

RCM restructuring involves evaluating the current medical billing process and establishing goals to boost revenue and enhance patient satisfaction. With the expertise of 3rd party medical billing companies, a dedicated team provides support, bridging gaps, and implementing updated operational modules. Regular evaluations and feedback gathering ensure ongoing improvement and maximize efficiency and satisfaction. Leveraging the expertise of 3rd party medical billing companies, healthcare organizations can restore their medical billing operations to optimal functionality, ensuring streamlined processes and improved patient satisfaction.

Step 6: Denial & AR Management 

Effective claim denial and Accounts Receivable (AR) management are critical for maximizing revenue and maintaining financial stability. A thorough analysis of denial trends, timely resubmission of denied claims, and proactive communication with payers are key aspects of claim denial management. AR management focuses on optimizing the collection process, reducing aging AR, and improving cash flow. Accurate tracking of unpaid claims, efficient follow-up with insurance companies and patients, and the implementation of effective strategies for timely reimbursement are key areas where 3rd party medical billing companies can excel, ensuring robust AR and denial management.

Step 7: Coding Management 

Accurate and consistent coding of medical procedures and diagnoses is essential in healthcare. Coding management involves assigning standardized codes to patient records for billing, reimbursement, research, and data analysis purposes. Skilled coding professionals from third party billin companies stay up-to-date with the latest coding guidelines and regulations, review medical documentation and assign appropriate codes using systems such as ICD-10, CPT, and HCPCS. Accurate coding management supports proper reimbursement, reduces claim denials, maintains compliance, and facilitates efficient healthcare operations. Accurate coding management supports proper reimbursement, reduces claim denials, maintains compliance, and facilitates efficient healthcare operations, further enhancing revenue cycle management.

Step 8: New Claims Transition 

The claims transition is a critical phase in revenue cycle management. Efficient handling and processing of newly generated claims for billing and reimbursement purposes are crucial. With the support of 3rd party medical billing companies, healthcare organizations ensure accurate and complete information is captured, coded, and submitted to payers in a timely manner. By prioritizing a seamless new claims transition, healthcare providers can minimize claim denials, reduce payment delays, and improve revenue cycle efficiency. Thorough verification, coding accuracy, and proper documentation support the claims, optimizing revenue, and financial performance, and maintaining a healthy cash flow in collaboration with 3rd party medical billing companies.

Efficient revenue cycle management is crucial for healthcare organizations to thrive in today’s dynamic healthcare landscape. Collaborating with reliable 3rd party medical billing companies can significantly streamline billing processes and maximize revenue. By incorporating steps such as conducting a Lost Revenue Audit, collaborating with revenue optimization consultants, leveraging Robotic Process Automation (RPA), establishing transparent Service Level Agreements (SLAs), RCM restructuring, managing denials and Accounts Receivable (AR), ensuring accurate coding, and prioritizing seamless new claims transition, healthcare organizations can enhance their revenue cycle management with the expertise and support of 3rd party medical billing companies.

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I’m a multi-certified revenue cycle management professional and compliance officer with 20+ years of experience. I contribute articles to leading healthcare publications and journals. I am currently working as Senior Transition Manager, in BillingParadise headquartered at Diamond Bar, California. BillingParadise offers Medical Billing Services that intersect perfectly with the EMR/Practice management system you use.BillingParadise has offices in New Jersey, New York, Florida, Georgia, Minnesota, and Texas.

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