Highly Neglected Revenue Cycle Processes - PowerPoint PPT Presentation

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Highly Neglected Revenue Cycle Processes


In this article we discussed, the highly neglected revenue cycle processes, their impact on revenue collection, and why providers are neglecting them. – PowerPoint PPT presentation

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Title: Highly Neglected Revenue Cycle Processes

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Highly Neglected Revenue Cycle Processes
For most providers, the revenue cycle process
means submitting claims and wait for payer
reimbursements. These providers are under the
impression that if they submit the claim, it will
get paid but thats not the case. Revenue cycle
management includes really crucial processes like
provider credentialing and contracting, Benefits
verifications, prior authorizations, and
out-of-network billing to name a few. Practice
owners neglect such crucial revenue cycle
processes as they dont have to do proper billing
knowledge and they try to do it all. In this
article we discussed, the highly neglected
revenue cycle processes, their impact on revenue
collection, and why providers are neglecting
them. Impact of negligence in revenue cycle
processes Eligibility and Benefits
Verification As mentioned earlier, most
providers feel if a patient has active coverage,
then their insurance will cover services provided
but thats not the case. Doing eligibility and
benefits verification is the backbone of revenue
cycle management.
Highly Neglected Revenue Cycle Processes
Benefit reports will provide details coverage
report, and how the payer can provide
reimbursements, patient responsibility and if any
prior approval is required. You can take benefits
reports from billing software or from provider
portals.   If you want detailed benefits report
you can call the insurance carrier and talk to
the rep. The insurance rep can share detailed
eligibility report with you and can reply to your
questions like which procedures codes are payable
and reimbursement rates for them. Train your
staff on how to get and read benefits report.
This activity will ensure all your patient visits
are getting paid (either by the payer or by the
patient). Prior Authorizations Prior
authorization is another revenue cycle process
which is neglected the most. Most providers are
under the observation that if a patient has
active insurance that means their services could
get covered. Now a days most of the patients are
buying high deductibles plans, which is
increasing patient portion to great amount. Under
new fee-for-service plans, not all services are
covered, you have to communicate with the
insurance company and get their approval to
perform certain procedures.
Highly Neglected Revenue Cycle Processes
Most practices avoid doing prior authorizations,
due to a lack of specialized billing experts.
Most of the denials received due to lack of prior
authorizations can be appealed. Without proper
prior authorizations in place, providers are
leaving a lot of money on the table. Provider
Credentialing Provider credentialing is the
practice of ensuring that providers have all of
the necessary training and experience to safely,
efficiently, and effectively practice medicine.
Provider credentialing exceptionally
time-consuming process and needs experts who
understand all the documentation part. In
credentialing you have to maintain credentials
with both government and commercial payers,
including Council for Affordable Quality Care
(CAQH) quarterly re-attestations. Every payer
has their unique credentialing guidelines, which
need to be followed for quicker credentialing.
You will have to access payers in your area of
service and accordingly start preparing for
credentialing. Not paying attention to provider
credentialing while starting your practice could
cost your practice a lot. Payer Contracting
Highly Neglected Revenue Cycle Processes
Of all the things your practice has to do,
negotiating payer contracts could be the most
tedious and arduous part of running a healthcare
practice. A large part of the success or failure
of your practice could depend on the partnerships
or lack thereof you have with payers. You can
outsource provider contracting services to a
medical billing company who can take the stress
of managing payer relationships and negotiating
contracts. Medical billing companies can review
existing payer contracts, make recommendations
for fees and reimbursement, and keep track of the
negotiation progress from start to
finish.   Workers Compensation Workers
compensation collections can be incredibly
difficult to manage for providers due to the
special terminologies, unique collection forms,
and many legal obstacles. Workers comp is
extremely specialized and does not follow a
single set of rules, as every U.S. state has its
own laws and regulations. That can cause a lot of
headaches for any billing department. While it is
very difficult to manage, there arent that many
cases of workers comp, as it only accounts for
up to 5 of a hospitals accounts receivable, so
healthcare providers rarely allocate additional
funds to hire a workers comp expert. Out of
Network Billing
Highly Neglected Revenue Cycle Processes
Out-of-network billing can provide a big revenue
stream for your practice because they allow you
to bill as much or as little considering you
are not bound by the terms and conditions of a
payer contract. However, not having on-hand
expertise can delay payments. With a service
provider like CareCloud, everything from sending
claims and posting payments, to negotiating the
payment from the payer and working with the
payer, to paying the negotiated amount, is
handled externally. This frees up even more time
and money for you to allocate toward bettering
patient outcomes. When it comes to out-of-network
billing, utilizing a team of experts who can help
you maximize your revenues is a
no-brainer. Handling revenue cycle management
requires expertise in medical billing and coding
as per the medical specialty.  When providers try
to handle revenue cycle management on their own,
then they might end in neglecting the crucial
revenue cycle processes. By outsourcing, you can
collect reimbursements for all offered services
and at the same time, you can provide quality
patient care. Medical Billers and Coders
(MBC) is known for providing complete revenue
cycle services. Our services include charge
entry, payment posting, denial management,
accounts receivable, medical coding and provider
enrollment credentialing. To know more about
our services, contact us at info_at_medicalbillersand
coders.com / 888-357-3226
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