What is the significance of physician revenue cycle management for a practice? It is the procedure that helps to track payments and revenue collection from the patient. It starts with the procedure of registration and scheduling of patients, proceeds to insurance verification, charges entry, physician medical billing, claims scrubbing and submission, payment posting, claims denial management, A/R follow-ups, and compiling collection statements.
Did you know? More than 23% of the total healthcare providers in the United States are independent practices which mostly comprised of solo physicians or a group of 2 to 5 physicians. Along with this, there are some medium-sized medical businesses that comprise of 31 to 100 physician physicians that represent 11% of the healthcare community.
These independent practices represent a major part of the medical providers and manage most of the care delivery systems along with hospitals and large-sized medical businesses. However, these small and medium-sized businesses are facing a host of physicians billing services challenges that started almost a decade ago with the HITECH act that endorsed technology-based reforms. These physician practices were required to adopt electronic health records (EHR) systems and many other clinical technologies that thrust upon a budgetary burden and operational costs.
More than ever, medical practices are also concerned about their collection and revenue goals. Physician billing services and other financial procedures require consistent working of dedicated resources to manage payment claims, payment follow-ups, and physician revenue cycle management. The physician billing services is a combination of the front desk and back-office tasks that are linked together like a chain and even a small glitch in the workflow can impact the overall process. Therefore, unified processes that can reduce the communication gap between both the departments to improve the revenue cycle.
Every step of the physician billing services must be taken accurately. Also, make sure the optimized workflow that is essential for providers to meet targets and is critical for the financial success of a practice. Various factors impact physician billing services and aid to optimize the revenue collection.
1. Optimized front office processes
The basis of the overall physician medical billing services is the data that is collected by the front office staff during the registration of the patient. Therefore, if the front end staff fails to register patients properly then it gives rise to the problem right from the scheduling. It results in missed slots and increased wait time for patients.
Physician’s practices must have an immaculate system of patient call handling and appointments there must be a scheduling system integrated the physician revenue cycle management system which can ensure steady patient check-ins.
2. Patient visits and optimal clinical flow
After the front office, the most critical phase of the physician billing services consists of the optimized functioning of patient costs and walkthroughs in the care process. The clinical segment of the physician medical billing cycle is where visits documents are compiled together.
At this stage, errors and omissions can negatively impact the revenue cycle. Medical billers prepare bills on the bases of clinical notes and completely depend on the information provided by the provider during the visit of the patient. Medical billing specialists prepare medical bills on behalf of the collected information. Therefore, physician billing services can lead to failure in reimbursement collection due to incorrect information used to prepare bills.
3. Role of medical billing in revenue cycle management
The medical billing phase represents the most important part of physician revenue cycle management. Billing problems, such as incorrect CPT codes that don’t match with diagnosis, errors in ICD codes, faults in the patient demographics, and patient health information or absence of insurance verification lead to a shattered revenue cycle for the physician’s practice.
Billing is critical for successful completion of the revenue cycle and the billers must be trained to code and accurately prepare bills, crosschecking and verification of the information, co-pay collection, and claim to scrub, preparing the EOB, and posting payments.
However, it doesn’t complete here and continues to the phase where claims are submitted for reimbursements, payment follow-ups, claim denial management, account receivables, and compiling the patient statements. Optimization and management of the revenue cycle require consistency of burnout and draining of energies due to their involvement in administrative tasks.
Therefore, a majority of physician practices outsource the physician billing services and revenue cycle management to medical billing companies that can help them to achieve their revenue goals.
Our professional medical billing company is specialized in managing the revenue cycle for physicians and with their knowledge and expertise make the revenue collection process smooth. Contact us! To schedule a free business consultation.
The author Dennis P. Reed possesses a vast experience in the IT industry, especially in the domains of website and mobile app development and digital marketing. He writes on topics encompassing the above mentioned domains and is considered a maven in his chosen field – Information Technology.