Outsourcing can Help Overcoming Revenue Cycle Hurdles

Outsourcing can Help Overcoming Revenue Cycle Hurdles

Healthcare revenue cycle challenges exist at every stage of practice management, beginning with appointment scheduling and extending all the way through claims, billing, payment, and collections. Technology, regulations, changing contractual obligations and payer policies, people, processes, billing – each of these complexities add to the challenge. These Revenue cycle management (RCM) hurdles lead to revenue loss ultimately challenging the day-to-day activities of practice management. In this article, we will discuss how outsourcing can help overcoming revenue cycle hurdles.

Overcoming Revenue Cycle Hurdles

Consistent Denials

Claim denials are an obvious step in medical billing. As per industry standards, efficient medical billing can receive up to 5 percent of claim denials. What’s not acceptable is receiving claim denials for the same procedure codes again and again and not trying to find reasons behind it. Poor revenue cycle activities could lead to high denial rates, sometimes even 30 percent of submitted claims. Practices might face such a high denial rate due to the absence of a skilled billing team. Sometimes practice owners try to do everything on their own and even submit claims without a detailed understanding of billing guidelines.

Practice owners can’t dedicate much time to denial resolution activities due to their commitment to patient care. When you outsource your billing and coding activities to the medical billing company, they have experts who analyze the denial reasons. The billing company has experienced billers and coders who are well-versed in payer and medical specialty-related billing guidelines. Such an experienced denial resolution team from the billing company ensures that you have a resolution for every denial reason and appeal the claims on a timely basis. Medical billing and coding being core expertise, billing companies help practices to reduce denial rates drastically bringing them within industry standards.

Poor Collection Rates

Whether it’s insurance collections or patient collections, healthcare practices often struggle to collect payments. It’s always easier to collect payments on the first attempt. Payment follow-ups add comprehensive costs due to the time invested by your team. It’s easy to manage day-to-day practice management activities with timely collection of payments. Nowadays, as more patients are adopting high-deductible health plans, patient responsibility has increased exponentially.

Medical billing companies can assist you in the timely collection of insurance and patient payments. The billing company take frequent follow-up on submitted claims and ensure that any denied or rejected claims get appealed quickly. Due to various practice management activities, providers can’t take active follow-ups on claim status. Medical billing company like Legion Healthcare Solutions shares insurance coverage report for every single patient visit, a few days prior patient visit. This helps identify patient financial responsibilities like co-pays, co-insurance, and unpaid deductibles. With such a detailed insurance coverage report, you can collect patient payments at the time of the visit only.

Billing Errors

Medical billing and coding is a different specialization and most of healthcare providers haven’t taken any official training or certification for it. Providers trying to manage billing and coding all by themselves end up using a bunch of procedure codes to bill all their patient visits. Such billing practices could lead to the use of inaccurate CPT codes/ modifiers; bundling/un-bundling of codes; up-coding; or many other billing inaccuracies. Such inaccurate billing practices for a long time could attract external payer audits.

When you outsource to Legion Healthcare Solutions, your billing and coding activities are taken care of by specialty-wise billers and coders. Our well-trained and experienced billers and coders ensure that every single claim is audited properly before its submission to the payer. We constantly share various billing reports which help practices to understand key areas like the number of submitted claims, claim dollar amount, practice total collection, patient responsibilities, write-off amount, and many other RCM parameters. Such reports are great indications of the practice’s financial performance.

Legion Healthcare Solutions is a leading medical billing company providing complete medical billing and coding services. In a cost-efficient way, we can assist you in overcoming revenue cycle hurdles. To know more about our billing and coding services and how we can help in overcoming revenue cycle hurdles, contact us at 727-475-1834 or email us at info@legionhealthcaresolutions.com