Protecting, optimizing and devising strategies to maximize reimbursement, is fast becoming the top most priority of medical practices. From just taking a cursory glance at claims and being profoundly disinterested in the business side of medicine. Physicians have now become, more pro-active and engaged in their practice’s financial health.
Every single day is throwing up newer challenges and opportunities for healthcare practitioners. It is practices that evolve with the times that will survive.
The challenges faced by physician practices…
Small and medium sized medical practices with limited resources and manpower will be the most affected in the current healthcare climate. Small practices are certainly not circling the drain. But to keep the lights on despite mounting financial and regulatory pressures can become tougher and tougher…
Complex EMR systems, multitasking staff and patients demanding a few minutes more to discuss health concerns, ensure working 8 hours a day is barely enough. The revenue cycle consists of dozens of variable components and every single link has an impact in the food chain. A revenue cycle that is not tightly integrated enough can lead to revenue leaks. Compartmentalizing processes and working on each component is the only way of making sure that physicians will get paid for the efforts they’ve put in.
The entire RCM process can be categorized into five major phases…
- Pre-service that includes tasks such as prior authorization, eligibility checks
- During the process of care. Noting down exact details, maintain perfect OR records etc.
- Integrity and compliance roadmap. Maintaining charge-master, coding integrity, clinical documentation etc.
- Medical billing services.
- Administrative services like analyzing fee schedules, contract management and debt collections.
Taking care of financial, administrative and technical needs !
To stay profitable and reduce work pressure and inefficacy in any one are, practices should focus the triumvirate that is the magic mantra to more collections and streamlined workflow. Tracking metrics and receiving reports on all three functional areas is important to stay on top of the game.
The financial aspect consists of
- Medical billing.
- AR collections.
- Collection ratio.
- Pending AR management.
- Claim analysis.
The technology, systems, platforms and applications used fall in the technical category and the administrative side takes into account human capital and everyday workflow. A complete understanding and optimization of all three components is the only way medical practices can manage to keep their heads above water !
