Introducing DIY Revenue Cycle Management Team for your Organization

 Erika Regulsky Tags: , , , , Billing & Collections, Coding, RCM


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First time in the RCM industry, Introducing DIY teams to help you strengthen your Revenue Process

Each one of us at some point of time in our life may have undertaken Do-it-Yourself or DIY initiatives or projects. We draw great comfort when we successfully accomplish DIY projects, be it for modifying our homes, repairing pavers or fixing a dripping tap.  It gives us immense satisfaction doing things our way, without any professional intervention. Along the same line, BillingParadise with a long-serving vendor experience in Revenue Cycle Management has actively been introducing new ideas and concepts to improve the financial processes of healthcare organizations. 

The DIY concept in Revenue Cycle Management is the first of its kind innovated solution offered by our company.  This initiative allows practices and hospitals to hand-pick an RCM team of their choice, as and when they need. It eliminates the need for hiring an in-house RCM team. It also doesn’t bind an organization in any kind of a long-term association with an RCM vendor. The DIY concept gives you the flexibility of picking a need-based team either to administer all functions associated with patient service revenue, or selected streams of revenue cycle management.

Assemble your Denial Management Team

denial managment

Assume that your organization’s current need is for AR management, Patient Eligibility, Medical Billing, Coding etc.., and you have a bunch of cases that need to be reworked and resubmitted. Depending on the volume of cases, your organization will have the option to pick one or many denial specialists from a large repository of certified billing and coding specialist. 

DIY options give you full control over the process, each of our specialists goes through extensive training in coding, clinical documentation, and revenue cycle management. It leverages an organization to pick a qualified team of revenue cycle management specialist without the burden of training, overhead or software cost. 

Despite the Do-it-Yourself nature of the process, the RCM responsibilities of the organization stand minimized to the extent of just looking over the nitty-gritty aspects of the operation, while still having complete control over it. It allows the healthcare organization to designate a team to govern end-to end RCM operations, or segment them for each of the RCM categories.

DIY Denial Management Benefits

  • DIY Denial Management options provide you an access to customized premium software ‘DenialManager’ at absolutely ZERO cost.
  • This integrated robust software seamlessly integrates with any EHR.
  • It has capabilities of providing comparative analysis and predictive data, making the task of denial management easier, offering comprehensive denial management solutions, and eventually helping you lower denial rates.

DIY A/R – Hand Pick AR Management Resources with Software

AR Specilaist

Every healthcare organization’s financial health becomes evidently clear when you analyze an A R report. Looking at a patient’s account and the discharge date, the length of time it takes for the medical claim to get paid is the key element of an    A R report.

If a patient visits a medical facility on a given day, and ten days following the visit the account has been paid in full by the payer, a zero balance in the A/R report signifies that operations of the facility are running efficiently. 

On the other hand, if the account wasn’t paid six months following the visit, and if it wasn’t followed up with the payer because of staff shortage or other exigencies, the operational efficiency of the facility is questionable, and in need of a thorough revamp.

This is where a medical organization’s A/R operations can benefit through DIY options, meaning, you pick an A/R specialist, who would be working remote but reporting to your organization like an in-house staffer does.

DIY Benefits for A/R Management

  • Eliminating A/R backlogs is the key to an efficient A/R management.
  • DIY options allow you access to an all important tool ‘AR Analyzer’.
  • This tool helps you streamline the follow-up process.
  • It lets you increase debt collection with great follow-up features and a friendly interface.
  • Advanced metrics lets you monitor individual performances of the RCM team.

DIY Patient Insurance Benefits – Hire full time Patient Eligibility resources 

Patient Eligibility

Maintaining a full time in-house staff for verifying patient insurance benefits can cost a health organization a fortune. But if you choose the do-it-yourself option, it lets you hire a part-time remote staffer, who is trained to verify patient insurance benefits on similar lines an in-house staff is trained.

Before the health facility provides care, the remote staffer will confirm from the patient, how they would be paying. If they are covered by an insurance plan, the patient’s insurance eligibility would be verified by the remote staffer, who would report to the hospital with the gathered information.

The DIY methodology does away the need for training an in-house employee for insurance verifications services. No salaries, benefits, or taxes have to be paid. Neither would the organization have to worry about turnover rate or staff absences from work. 

It is imperative for physicians to verify a patient’s eligibility benefits to make sure the clinic receives full payment for services rendered. The DIY option lets you stay focused on patient care, while patient eligibility verification services can be done by the remote staffer to confirm coverage prior to the patient’s office visit.

Above all, the health organization has complete control over the process. They can monitor the operation for quality assurance.

DIY Benefits for an Efficient Insurance Eligibility Verification

  • DIY benefits for insurance verification will allow practices utilize the verification tools of companies we’re contracted with for operations of our in-house billing and coding process.
  •  The verification tool will allow practices to know payable benefits, patient details, pre-authorization number, co-payments, deductibles, co-insurance, patient policy status, effective date, type of plan and coverage details, and plan exclusions.

DIY – Medical Coding by Certified Professionals

medical coder

The complexity of medical coding requires thoroughly certified professionals who can effortlessly complete claim documentations without inconsistencies. The accuracy is largely dependent on clear and concise clinical documentation. If the documentation is incorrect, or vital information is lacking, the claim will be rejected by the payer.

Certified coders on staff are not only expensive to hire, but difficult to find, they continue to be on high demand. Despite software being available for coding assistance, a knowledgeable coder is essentially needed to enter data and follow-up any discrepancies with clinicians, hospitals, and insurance companies.  

According to AAPC, the average annual salary of a coder in 2016 was $52,320; it would be marginally higher in 2019. The DIY option has great potential saving medical facilities considerable amount of resources, both financial as well as managerial. It facilitates organizations to hire coders at short notice, and on the basis of their needs. Although billing and coding are continuous processes, small practices stand to benefit hiring coders on part-time need basis. 

Our repository of certified remote coders can be of great value to small, medium or large medical facilities that are in need of supplementing their billing or coding operations, or completely migrating their claim documentation  to remote resources. The remote coders can work in coordination with the hospital’s billing office, with major functions controlled by the health facilities administrative office, and claim documentation support processed by remote coders. 

The remote coding workflow begins with a physician after completing a procedure, sends the medical charts electronically to the remote coder, who reads and codes. After a thorough review, the coder expeditiously sends the charts back to the hospital or practice. Our remote coders can effectively and efficiently contribute to the financial success of your health facility. They can help your organization get reimbursements accurately and on time.

DIY Benefits for Accurately Converting ICD-9 to ICD-10 Codes

  • The ICD-9 to ICD-10 conversion tool facilitates coding efficacy and lowers denials.
  • It lets you edit ICD-9 mistakes in the reporting system, and converting it into ICD-10.
  • The Codes can be searched numerically or by description letting you save the results for future use.
  • It also enables multiple keyword searches as you type.
  • The ICD codes can be printed or shared through email.
  • They can be accessed anytime from anywhere using Quick ICD 10 web app.
  • The past searches too are saved in history, expediting the next conversion.
  • The tool goes beyond standard ICD conversion utility through the ‘Similar Codes’ search feature, with the convenience and ease of locating the most specific ICD 10 code.

DIY – Medical Billing to Overcome Staff Shortages

medical biller

Medical billing like its counterpart medical coding is equally complex, with legal regulations, frequently changing codes, and Medicare and HIPPA compliance issues adding to its complexities.

Besides, the multiplicity of insurance types, which include Fee-for-Service (FFS) Medicare, Medicare Advantage, FFS Medicaid, Medicaid Managed Care, and private having their own documentation requirements, it makes the billing process exhaustive to implement.                                                                                             

The complexities apart, medical billing is an important element that influences cash flow and the bottom-line profit of hospitals and practices.

Physicians that attempt doing their own billing and collections tend to lose 10-13% of their billing to write-offs.  They have to wait months for their payments, because follow-up with payers are irregular, and not pursued diligently.

Do-it-Yourself options let you process billing operations in-house, the only difference, that major billing responsibilities will be shared by independent remote billers. Despite billers working remote, their coordination with the financial departments of the facility will be as good as having in-house billers, and at one-third the cost. The financial and billing departments would be in complete control of operations, except billing and coding processes, which would be remotely implemented.

DIY options help you overcome staff shortages, without stalling in-house billing operations, ensuring that the claims get processed in an average 22 days cycle, and collections increasing rapidly to 99.7%.

DIY Benefits for medical billing

  • One of the most valuable DIY benefit for medical billing is that practices will be able to hire resources that are certified, and with a deep knowledge of all aspects of medical billing.
  • This includes insurer requirements, the rules for Medicare, Medicaid all relevant billing codes.
  • All billers assigned for DIY billing operations are accomplished and proficient with complex state and federal regulations, including HIPAA and Stark laws.
  • The billers will have sufficient experience dealing with patients, answering any billing questions with calm demeanor and patience, besides providing them contact information and making follow-up calls.

DIY – End-to-End RCM to Improve Cash Flow

DIY-RCM

Revenue Cycle Management throws up multiple challenges each day, declining reimbursements, high deductible health plans, and tighter profit margins are some of them, that practices have to confront.

It is imperative that end-to-end RCM processes are efficiently in place for running a remunerative practice.  In order to make that happen, an alert revenue cycle management team has to ensure that revenue doesn’t slip through the cracks. 

Practices lose almost 25% of revenue as a result of poor medical billing and RCM implementation. In a study by Medical Group Management Association (MGMA), it costs a practice an average of $25 to $30 for reworking a claim. 

In another study, the American Medical Association found that one in five medical claims that were submitted to payers had inconsistencies such as incomplete patient information, treatment, and incorrect diagnosis codes. These inconsistencies can be attributed to practices facing shortages of qualified billing staff, and inexperienced and untrained staff filing claims.  As a means of overcoming qualified staff shortages, and successfully running end-to-end RCM operations, DIY options can be the game changer.

Depending on the size of your practice or volume of operation, we have a repository of RCM talent, which can remotely provide end-to-end RCM support for an improved bottom-line, and an efficient financial management. Our remote professionals will assume complete control of the end-to-end RCM operations of your organization to increase the cash-flow and improve the bottom line your revenue cycle.

DIY Benefits for End-to-End RCM

  • The DIY benefit of a comprehensive revenue cycle management allows you free access to ‘theBillingBridge’ application.
  • It integrates with all EMR’s, this workflow and reporting platform allows you to plan and analyze your decision implementation quickly.
  • The tool has the capability of generating complex on-demand revenue cycle reports.
  • It also has an inter communication utility for communication between different members of revenue cycle management team.

Running An In-House RCM Process With Zero Staff Overheads

RCM

The Journal of the American Medical Association (JAMA) implemented a cost study last year on time-driven activity–based cost, and what they found was 25 to 31 percent of total health care expenditure in the US was related to administrative costs. The association chose a large academic healthcare facility with a certified health record system. The study concluded that 62 percent of their costs were for billing and insurance related operations, almost $20 per primary care visit.

These administrative costs can certainly hurt providers, already under pressure from insurers and the rising cost of care. In these circumstances, every dollar they are entitled for reimbursement becomes valuable. 

As the study points out that 62 percent of their costs were for billing and insurance related operations. Therefore, it’s vital that providers while retaining control over certain important aspects of revenue cycle management look for avenues that can save cost on billing and insurance operations. 

In order to maintain billing and insurance operations in-house, the providers can hire remote billing staff that is certified, and have the capabilities of providing comprehensive end-to-end revenue cycle management. 

They can also hire remote staff  for insurance verification, coding/charge entry, pay posting, claims submission, following up on unpaid claims, tracking claims, AR/denial management, appeals and reconsideration/redeterminations, and patient statements/collections of remaining balance. The DIY methodology helps maintain primary RCM functions in-house, while secondary operations are remotely processed.


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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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