Category Archives: RCM Consulting Services

As a leader in Healthcare Revenue Cycle Management Consulting, Nearterm is uniquely positioned to offer insight & solutions to common RCM challenges.

Why Is Revenue Cycle Management Important in the Healthcare Industry?

what is revenue cycle management in healthcare?

Revenue Cycle Management (RCM) plays an important role in the healthcare industry. Managing revenue is vital for any business but may not be the primary focus of healthcare providers. However, these providers need revenue to pay for medical supplies, salaries, equipment, and more.

Healthcare costs are increasing with technology adoption in a time when an aging population is foreshadowing increased demand for care. Insurance and medical suppliers are placing an increased burden on patients and providers. Value-based healthcare payment models are also reshaping how providers can approach revenue cycle management.

What Is Revenue Cycle in Healthcare?

Revenue Cycle Management is how an organization handles the finances and processes associated with different steps of patient care from start to finish. It begins when a patient is first encountered or scheduled for an appointment and continues through the services provided to the billing afterward. Patient scheduling offers the opportunity to gather information vital to the claims process, such as insurance information, to verify eligibility.

The healthcare revenue cycle process includes coding medical services and billing insurance. Making sure that patients have eligible insurance on file can help in determining costs for various treatments. Faster and more accurate claims transmission allows for greater flexibility in arranging patient care.

After medical services have been provided, another key medical billing RCM process emerges. Managing past due patient accounts and accounts receivables impact the provider’s cash flow through collection times. The revenue cycle in healthcare also includes bad debt or managing uncollectible patient records. When patient accounts are up to date, the cycle continues with scheduling the patient’s next visit and perhaps even offering reminders.

What Is Revenue Cycle Management in Healthcare?

While there are variations between provider types and how the specifics are handled, medical revenue cycle management revolves around the finance and administrative side of the organization.

What is RCM in medical billing? This includes not just patient collection issues but also costs and efficiency of claims submission. These factors are also impacted by staff training.

revenue cycle management process in medical billing

Medical billing has been impacted by recent changes to healthcare models that now focus on value-based care. In addition to this, medical providers have also recently been required to transition to new diagnosis codes ICD10. For more information on understanding the hospital revenue cycle and for assistance with various related issues, consider Nearterm’s Healthcare Revenue Cycle Consulting.

Why Is Revenue Cycle Management Important in the Healthcare Industry?

There are many benefits to efficiently managing your revenue cycle. The overall goal is to increase revenue throughout the various processes by first identifying points of friction and then resolving them.

These problems may include fraud, waste, and abuse such as unnecessary tests and procedures. For some healthcare providers, revenue and finances are not the primary concern. Some may be more focused on patient care.

Problems and issues with an RCM process in healthcare can impact various other processes and take time away from patient care or medical training. The rapid pace of technological improvement has also greatly improved medical billing through electronic data interchange made available by healthcare clearinghouses and electronic claims submission. Technology has improved many other areas but also resulted in new security issues.

Medical revenue cycle management also includes medical records and how they are accessed and stored for billing purposes. Recently there has been an increase in attacks on medical organizations aimed at accessing medical records. These records and other personal health information (PHI) are protected by federal law such as the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules.

Ensuring medical records are properly protected while processing financial information is a key concern that could potentially detract from patient care. This emphasizes the importance of health information management at your organization. Effective hospital revenue cycle management will include the security of PHI and patient financial information.

Finally, the RCM process in healthcare is important because it can be analyzed to find a process that can be automated safely leading to more time spent with the patient. For more information on why you should outsource your RCM administrative and financial needs contact the healthcare management consultants at Nearterm today!

Revenue Cycle Management Process in Medical Billing

why is revenue cycle management important in the healthcare industry?

The healthcare revenue cycle management process traditionally involved long delays between patient care and associated payment as claims submission was a lengthy process. This is the communication between healthcare providers and the patient’s insurance companies to negotiate payment for services as well as negotiating payment with patients.

What insurance will pay for is impacted by many factors including the patient’s specific plan and what diagnosis codes the provider submits. The medical billing RCM process involves preparing a claim and sending it the insurance. These days technology allows for rapid claim inputting and submission as well as automated “scrubbing” to ensure these claims meet basic requirements for acceptance.

Claims can be rejected for a wide range of problems ranging from a lack of information, improper coding, compatibility issues, and system errors. The number of claims that pass on their first attempt is a key metric to consider in the revenue cycle for medical billing. Multiple claims rejecting for the same errors could be caused by problems with the inputting process as a result of a lack of training. They may be resolved with the proper medical billing denial management process.

Electronic claims can allow for immediate approval for procedures and services from a patient’s insurance company. This can allow a provider to offer a range of services to the patient and increases the likelihood of receiving associated payments. Thus efficiently managing claims allows for greater flexibility in patient care concerning their finances and ability to pay. It also allows the potential for decreasing collection times on services which translates to increased cash flow and better Key Performance Indicator ratios.

On the extreme side of the revenue cycle is the issue of outstanding payments leading to bad debt. Managing the collections process is not always pleasant and will detract from providing valuable care to patients, especially to those in need. Some providers choose to write off the bad debt as a loss.

Efficiently managing RCM, at many different steps in the process, may help to decrease the number of cases that reach bad debt. One powerful solution to these issues is to contract with a third party Healthcare Revenue Cycle Management company. Nearterm’s Healthcare Management Consultants can offer experienced RCM consulting to help increase cash flow, lower bad debt expenses, improve patient satisfaction with financial services, as well as reduce operating costs and increase productivity.

Contact the Nearterm team oday for more information about how our services can make you more productive and profitable.

 

Posted By: nearterm-admin

“I promoted the best AR Specialist in our organization to a management position – oops!”

Here is a story from one of our clients that you may find interesting;

Things were in good shape in our revenue cycle management process. Metrics and the Dashboard indicated that we were current in billing, follow-up, and cash application. Denials were under control. Days were low. Patient complaints were handled promptly. You get the picture.

I attributed a lot of this sustained success to one of our team members (let’s call her “Julie”) who had been with us a long time and had worked effectively in patient access, billing and denial management. Julie was very knowledgeable about our system, got along well with coworkers and had good social skills. A model employee!

Passing the Patient Accounts Torch

When our Patient Accounts Manager retired, we were tasked to fill the vacancy. The Patient Accounts Manager had done a great job so this was not a “turnaround.” He was a natural leader, knew the technical side of the business and understood the multidisciplinary processes and relationships that are so important in RCM.

We thought Julie deserved a shot at this position and that she could apply her technical knowledge in a management capacity. Our management team was unanimous that we should offer her the opportunity, so we did not initiate a search nor did we engage an interim manager. It was understood that the management team would all mentor her in the transition. We offered Julie the position and she was flattered and delighted to accept so we introduced the change.

After a short few months, performance began to slip. Morale declined. Julie was stressed and unhappy. Team members and colleagues came to grips that they had made a mistake promoting Julie to a management position.

The result was that they

  1. lost Julie, one of their best technicians
  2. burdened the organization with poor management
  3. are now in the costly process of recovering.

5 Lessons for Filling Vacancies

Here are six learnings that can be applied when vacancies occur:

  • Consider the entire universe of talent that is available to fill the vacancy instead of limiting your search to internal candidates. It is not about who is deserving or qualified – it’s about who is best.
  • Give yourself time to make informed decisions that will serve you well in the long term. It is often advisable to bring in interim management services to get you through the vacancy transition until permanent leadership can be identified and hired or promoted.
  • Recognize that being a great technician is an entirely different skillset than being a great manager but no less important. Other countries have embraced this and redefined culture so that technicians can advance their “status” and compensation on a scale equal to managers.
  • Succession planning is not just for the C-Suite. Every position in the organization is important or you probably would not have it there in the first place. Design a plan that addresses what you would do in the event of vacancy for each position. It is not necessary to name a successor, but it is important to have a plan. For example, would you promote from within, reorganize, engage interim help, rely on internal recruiting or go outside for talent acquisition? The answer may vary from one position to the next.
  • If you have your eye on a candidate for internal promotion, assess training and development needs well ahead of offering the promotion. Let the person know what development goals they would have to accomplish in order to advance and invest in them.
  • If you are in a rural community or a location where the talent pool is limited, you have a “make or buy” decision when filling a vacancy. If you decide to “make”, it is imperative that training resources are prepared and that you have the time to allow an inexperienced person to get up to speed. You must also be prepared to quickly assess the capability of the new hire to absorb the training and be effective in your organization. Hiring inexperienced staff is expensive and can be a distraction to the rest of the team. However if you decide to “buy”, you should expect highly trained candidates with strong experience. The training curve is minimized and you have the opportunity to vet a range of talent. Often, you can introduce interim management resources that strengthen your human capital “gene pool” and elevate overall performance that is sustainable.

Perhaps these ideas will help you avoid losing your best technician while making an ill-advised promotion.

Posted By: nearterm-admin

SILENT IMPRESSIONS

Every encounter we have with another person or a business results in an impression. An encounter may be conversation, email, voicemail, text, social media, appearance, hygiene and others. Some of the impressions we form based on these encounters are stronger than others and because people are all different, reactions vary. Some impressions are indelible and others can be replaced by subsequent impressions. Every impression formed by a person, either positive or negative, can be called a “moment of truth”.

However in any case, impressions are actionable in terms of future decision making, willingness to start/continue a relationship, buying services and drawing comparisons to other people and/or businesses. When impressions are favorable, the likelihood of a continued relationship increases and the opportunity to strengthen such a relationship is available.

The problem is that when they are negative, we rarely know about it – ergo “silent impressions”. Business potential and new friendships are blocked by the negative impressions that have been formed. Worse yet, these impressions are often shared with others who then form their own impressions based on hear-say.

The Impact of Healthcare RCM on Your Brand

As leaders in healthcare revenue cycle management, we have responsibility for millions of these “moments of truth” every day. Every patient encounter, phone call, visit, email and snail mail represents an opportunity for a patient, visitor or family member to form an impression.

Same goes for the physical appearance of the hospital facility and work areas.  However, the presentation of our bills to payors and patients is a big part of the revenue cycle work product and “silent impressions” formed about those items can result in disregard that leads to the electronic (or hard copy) trash can instead of your lockbox. Of course, you have reports and data designed to alert you to claims denials, trends and edits etc. – all good. However, if you are relying too much on external feedback to evaluate the efficacy of billing or other functions, just remember that those “silent impressions” are out there and you will not likely hear about them.

I have blogged before about the value of conducting a “moment of truth” audit in your hospital. I would be very interested to hear of the results if you have. If you have not and would like to talk about methodology and the benefits, please contact me online or give me a call at 888-646-1330.

Posted By: nearterm-admin

Hospitals Staffing Levels Improve With RCM Solutions

rcm solutions

There’s no doubt that healthcare workers are the backbone of the health service, so it makes sense for a healthcare provider to manage their staffing levels in a strategic manner. Healthcare revenue cycle management consulting services (RCM) help hospitals to meet staffing needs while saving money. This cost-effective approach is gaining momentum as healthcare providers strive to offer excellent care while meeting business needs.

The Market Is Changing

Nowadays healthcare workers enjoy the freedom of being able to work flexibly and at different locations, because they don’t like the idea of being tied down to one place. Also, they like to make the most of the opportunities that arise at any given time, because they understand that this will add to their employment portfolio. This model is also beneficial for healthcare providers, as it makes the process of hiring skilled staff easier, and because contract workers often get paid a little more than in-house staff, they don’t have to offer benefit packages.

According to Global Human Capital Trends 2015 series, more than one-third of all workers in the United States are contract workers. What’s more, just over half of all respondents say that their need for contingent workers will continue to grow over the next three to five years as the market shifts toward a more agile workforce.

Contract Workers on Demand

Many firms rely on contract staff to meet supply and demand, but with hospitals, the need for contingent workers is even greater, because they simply can’t afford to be understaffed. Healthcare providers constantly need to meet their patients’ needs so that they can provide a good level of care.

rcm solutions

Nearterm’s 360 Managed Services can help you meet your staffing needs by meeting with you to discuss your requirements. Project staffing involves meeting with one of our experts to ascertain the type of workers you are looking for. This will include skill set, the scope of work, project details, schedule and other related matters. Once this has been established, we gather the resources you need and arrange for them to be there as and when you need them, both on-site and remote.

Revenue Cycle Management Service

RCM services manage a number of business-related tasks so that you can get on with what you do best: caring for your patients. These RCM services include:

  • Situation Analysis — Objective operations assessment to facilitate planning and decision-making processes.
  • Operations Action Plans — The plan of action process is a proprietary service wherein Nearterm leads your organization through a very structured process aimed at establishing targeted change.
  • Implementation Assistance — We deliver the additional ”horsepower” you need when implementing certain planned activities.
  • Organization Development — Our team of professionals serves as the catalyst your organization needs in the development process.
  • Centralization and Decentralization — We specialize in assisting providers with all aspects of centralization and decentralization, from the earliest consideration through the continuum.

In addition to RCM services, we also:

  • Present customized training programs
  • Develop and document policies and procedures
  • Provide conversion assistance
  • Design reporting packages
  • Tailor our services to meet your organization’s specific needs

RCM services help you to plan better so you can deliver top-quality care in this increasingly competitive market.  Hospital finance departments are often under pressure to crunch the numbers and balance the books. But without careful planning, recruiting staff can be more expensive than it should be. If you want to find out more about what we can do for your organization, please get in touch.

Posted By: nearterm-admin
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