Home Health Why do Practices Require Healthcare Revenue Cycle Consulting?

Why do Practices Require Healthcare Revenue Cycle Consulting?

Healthcare revenue cycle consulting

There are several opportunities and challenges in the revenue cycle that practices need to be paying attention these days. Healthcare revenue cycle consulting is going to help providers reduce the level of risk and be compliant with what the insurance companies require. Reimbursements continue to shrink and insurance companies have ever increased demands on the provider regarding documentation. One should put forward a great deal of effort at compliance determining regulations, and beware of inadvertent frauds in medical practice. Even with the best line of people at their practice, every now and then the system might face failure and healthcare providers are under a lot of stress. Most important thing is to pay attention and have experts to advise and guide you to success.

Major Scenarios Requiring Healthcare Revenue Cycle Consulting 

Many times, practices are noncompliant in coding and one of the common areas were people make mistake is in the evaluation and management codes. There are very specific guidelines set down by state and commercial insurance payers on what level of EM code qualifies for what you document in the encounter notes. If it is not in the documents, the paid auditors from the government are on a look out for practices that are over -coding, charging the payer more than what is documented in their note. The fine is quite substantial for noncompliant documentarian practices. 

Healthcare revenue cycle consulting involves chart auditing services. Sometimes, providers are afraid of getting caught and perform under coding. Their documents show higher level of service compared to what they are billing for. There are improper billing practices too. External auditors work with internal auditors and examine the documentation procedure, by looking at over coding and under coding protecting them and helping them to find additional revenue at times.

Talking about the need of covering date of service and eligibility sometimes the patient may be ignorant of the status of their coverage. Valuable service will be provided to them but chances are the provider is not involved in the network of the payer for a particular medication and after 45 days after service you realize you cannot bill the patient and payer sheer bad luck. Many practices lose money by not checking their patient’s eligibility according to the date of service.

Another aspect of good collecting work in RCM is making sure your front office staff are prepared to collect as much money as they can on the date of service. Healthcare revenue cycle consulting advises you to collect what is obligated from the patient right after the insurance company has explained to you and the patient how much will be covered.  This way, the patient can have surety on how they are going to pay the balance after receiving explanation of benefits. An email can be sent to the patient and collect balance against the card on file.  This Cuts down the write offs for average practice to a major extend and practices see dramatic increase in the account receivables.

Counselling and Healthcare Revenue Cycle Consulting 

In addition to implementation of right software, the above steps are also essential to compensate for poor staff work that put you in a bad place. Consulting with providers and going after those claims that has been sent on the provider’s behalf to insurance companies is the first line of action. Also encouraging them to apply the new methods, follow up on those claims to check for hidden opportunities to collect money.  In the current scenario of high deductible insurance plans, converting a patient obligate to collectible is more important.

Another goal of healthcare revenue cycle consulting is follow -up on claims. Make sure they are clean with right codes, checked eligibilities, money collected on DOS. Practices often time don’t do this with due diligence and timely fashion. And causes a loss in income and damages to the practice. 30% of claims has to have some follow ups. One should call the payers, look up those outstanding claims and find out why they hung up on the process. This work is time consuming and tedious. But it determines the difference between a profit and just staying afloat for many practices.  

It is advised to stay in touch with the reports that are coming out of their software; the AR reports will tell you where you should focus, where your resources need to be, your AR status, why the insurance companies are dragging their feet, what type of claims are delayed etc. the reports and data analytics can also tell you how are you doing from a production stand point regarding overall cost of practice. Also shed light on how are the individual providers doing at your practice compared to one another and national averages. Other management insights include, if you have the right mix of insurance companies in place like higher percentage of patients subscribed to govt payers. 

Healthcare revenue cycle consulting also helps with the customer service element which is very important for referrals and better patient inflow. Marketing and management of reputation with external assistance constantly boosts the health of a practice.