Robust RCM Systems: Keys to Effective Coding, Billing and Collections

July 25, 2023

Effective coding, billing and collection processes are vital to ensuring timely and accurate payment for practice services. In the absence of strong procedures and systems, you put your medical group’s financial stability at risk.

Establishing robust protocols allows you to optimize the billing and collections stages of your revenue cycle while enhancing your ability to provide exceptional patient satisfaction. 

Challenges to Effective Coding and Billing 

The path to effective medical billing is strewn with challenges. Physician billing managers must be equipped to handle the complexity of healthcare reimbursement rules and changing payer requirements in a landscape of constantly evolving regulations. The coding team must also be trained in the new coding regulations as well as continually kept up to date with important payer feedback. 

Many patients are now responsible for a larger portion of medical costs, so it is crucial to understand their ability to pay and offer alternative payment plans for those who require greater flexibility. 

Patient preferences in how they want to be billed are changing. Many, especially millennials, prefer digital-first billing technologies so that payments can be made easily via a smart device or laptop. 

The bottom line is that medical groups must regularly review their billing processes, identify areas for improvement, adopt the technologies that will lead to vast improvements, and make necessary changes to ensure medical billing processes are optimized. These activities are extremely costly and time-consuming. 

Challenges to Effective Collections 

Medical Group Management Association (MGMA) poll found that 56% of medical groups reported an increase in A/R days since 2021. Collections are slower and bad debt is taking its toll on many physician practices. Medical providers that fail to effectively manage collections place themselves at significant financial risk. 

Key factors contributing to collection challenges for physicians include: 

  • Lower reimbursements from Medicare, Medicaid and commercial insurers   
  • Increasing prior authorization and other claim denials 
  • Difficulty keeping up with the mountain of coding changes, such as the 2023 Evaluation and Management (E&M) coding guidelines  
  • Confusion navigating new regulatory mandates, such as the No Surprises Act which impacts pricing transparency and certain billing workflows 
  • High-deductible health plans are shifting more payment responsibility on to patients instead of insurers 

The healthcare climate continues to grow more complex. To make matters worse, many physician groups report difficulty finding and hiring highly trained revenue cycle staff, which in turn, impacts both the cost to collect and ultimately, revenue yield. 

Error-prone manual-driven collection workflows and processes that worked for years are no longer effective. Automation is impacting every stage of the revenue cycle, including collections. 

A Multi-Pronged Approach to Collections 

It’s clear that as the healthcare landscape evolves, your medical group’s billing and collections processes and systems must evolve, too.  An effective patient collection plan has different facets, including collecting payment at the time of service, sending patient statements, following up with patients, creating payment plans, supporting online patient portals and using call representatives.  

You’ll need to create metrics or key indicators for each facet of your collections efforts and use those metrics to monitor progress and adjust as needed. The goal of your collections efforts is to improve revenue capture rates while ensuring a positive patient experience. 

The Main Benefits of Working with an RCM Partner 

With the financial health of your practice at stake, handling coding, billing and collections in-house can be a costly mistake, not to mention putting you at risk for potential regulatory pitfalls.

The most successful medical groups work with a revenue cycle management (RCM) expert that specializes in optimizing revenue cycles and automating medical billing processes wherever possible, which results in fewer errors and faster payment processing.  

Outsourcing to an RCM expert can drive better financial outcomes for your practice.

Working with an RCM partner can also allow practice staff to focus on other important tasks, such as providing quality patient care, rather than spending time on administrative billing and collections work. Plus, a solutions provider that focuses 100 percent on RCM is better equipped to stay up to date with constantly changing regulations and industry trends, which helps your practice avoid compliance issues and remain competitive.  

Did you know that physician practices that partner with  R1 have improved patient collection rates by up to 20% while reducing the cost to collect by up to 20%?    

Start a conversation with R1 today to learn more about how R1 can help you solve billing and collections issues in your physician practice.

This post draws from content in our eBook, 5 Keys to Effective RCM Optimization for Physician Leaders.  Grab your copy now. 

Author: Jeff Gruber, SVP of business development. 40-years experience, with R1 since 2005. Working with Physician organizations of all sizes, structures and care settings.

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