With updated rules and a newly pruned reimbursement landscape, the uncertainty associated with the future of healthcare has not been made any clearer. In fact, the current environment may have seemed to muddy the waters further, making it even more difficult for healthcare institutions and independent clinicians to understand what is required of them in terms of reimbursements.
If your physician practice is associated with a revenue cycle management company, your RCM partner should be on top of industry changes and have a plan in place when new guidelines are introduced. To further ensure and verify that you and your affiliated partners are prepared, the following five questions should be asked of your RCM company.
Accurate coding is essential to ensure the optimal level of reimbursement. The rules for coding and the codes themselves often change from year to year, payer to payer and location to location.
How is your company educating coders on new changes? How is coding performance monitored? An independent audit should be performed annually to ensure that coding is optimal and compliant. Coding should then be reported to clinicians with suggestions on how to improve any documentation deficiencies.
2. How robust is your information technology infrastructure and support?
Revenue cycle management companies have transformed from being paper-based to electronic-based over the past 10 years. With the mandate for electronic health records (EHRs) and interoperability comes the transition of information electronically through a revenue cycle management system. A revenue cycle management company’s information technology (IT) infrastructure and support is key to handling the vast amounts of secure data being transferred through interfaces from the hospital, clinic, EHRs, labs, clearinghouses and payers.
Are you confident your information is safe? What redundancies are in place so data is always accessible when needed? The IT support team needs to make sure that systems are capable of handling the rapidly changing developments in healthcare.
3. What analytics are being done on the data to improve performance?
With all the data flowing in and out of the revenue cycle management system, what is your revenue cycle management company doing with that data to improve performance, monitor payer contracts and payments, reduce denials, ensure compliant coding and accelerate cycle time? Are analytics being provided to the clinicians/group to have a better understanding of your market, your payers, through put times, coding profiles, productivity, shifts in payer mix and seasonal trends so that you can position the group and the clinicians to mitigate market risks and capitalize on favorable trends?
4. How easy is it for patients to interact with the company and pay their bills?
With all the news about changes and potential changes in healthcare, there is uncertainty among patients on how to navigate through the medical system. The one certainty is that insurance companies are placing heavier responsibility on the consumer in terms of higher deductibles and making choices about where care is received.
Considering all the choices and decisions to be made, how easy is it for your patients to interact with your revenue cycle management company and pay their bills? Does your revenue cycle management company make it equally as easy for Medicare and millennials to both pay a claim? A Medicare patient may prefer a paper statement and phone call, while a Millennial may prefer to be pay their bills online or even through a text message. A clearer understanding of statements and other communications with your patients will benefit the perception of your practice, increase collections and accelerate the collection cycle.
Could you or your partner revenue cycle management company come up with clear answers to these questions? If not, work should be done to resolve any pitfalls or gaps in the future plan that could have potential consequences moving forward. Even if your revenue cycle management company could satisfactorily answer these questions, your mutual relationship should continue to be fostered. Open lines of communication and continued reaffirmation of a compliant plan for the future are going to be required if you wish to see continued reimbursement and, hopefully, increased collections in the years to come.