With the increase in HDHPs and high-tech innovations, practices and health organizations should equip themselves with the tools and resources necessary to optimize revenue cycles amid constant change. Keeping themselves up-to-date on the latest and most effective advancements in RCM and medical billing and being open to integrating new systems or methods will go a long way toward maximizing workflow and revenue.

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Outsourcing Medical Billing Services

For many reasons, some practices delegate billing and related tasks to a knowledgeable third party specializing in RCM. For practices that lack the resources or knowledge to contend with revenue management, outsourcing may be a good idea, provided certain factors are considered.

• Billing services require a subscription fee or a percentage of revenue. However, a good billing service should reduce claim denials, increase collections, and provide detailed reports on accounts whenever you request them. Even though you’re paying more for services, you may still generate more revenue than you would with in-house management. Consider what services are offered, whether there are clearinghouse fees, and whether the amount you pay includes co-pays collected by staff at times of service.
• Ask if the billing service employs certified coders or if your staff will be responsible for coding. If they have a coding system, make sure it’s ICD-10-compliant. The company should also be familiar with billing practices for your medical specialty and should be able to provide an analysis of your accounts with recommendations on how to improve revenue cycles.
• You should have real-time access to your practice’s financial data. Billing services should also be able to supply you with EOBs and other correspondence from insurers. Investigate how the company manages billing or claims errors.
• Patients should be able to access statements promptly. Most importantly, find out how long it takes to send unpaid balances to collections and whether the company offers patient portals to facilitate collections.
• See if the company hosts software from its own servers (so you don’t have to use your own) or, better yet, from the cloud.
• Some industry leaders are setting a new trend in revenue management by offering RCM services with successful EHR implementation.

New Requirements for In-House Billing

Likewise, if you elect to have your staff take care of RCM, it may be cheaper than outsourcing if you have the right tools. It’s best to provide software solutions that maximize efficiency and streamline processes. Software should enable you to uphold coding requirements and meaningful use standards set forth in ICD-10. You should also have on-demand access to financial data. Flexible software also encourages patient engagement with easy-to-read statements and cost breakdowns, with reminders about payment deadlines and multiple channels through which to pay.

Leading Innovations

Technology experts are transforming RCM with new products and services. These include online resources to educate staff about coding and billing, automated platforms that facilitate transactions between insurers and providers, coding apps, cloud-based faxing solutions, and improved analytics software. Other products, such as enhanced accounts-receivable management software and end-to-end RCM solutions, will change the face of revenue management in 2017.

Transparency Concerns

Since the prevalence of HDHPs is still relatively new, patients frequently receive bills much higher than they may have anticipated, often because they’re uncertain about how much was supposed to be paid by insurance. In other instances, misunderstandings arise about deductibles or in-network vs. out-of-network costs. Unfortunately, this can cause physicians to be seen as predatory billers. Practices need to be as up-front as possible when explaining costs or providing statements. Practice-friendly, patient-centered billing services can enable you to maximize revenue in 2017.