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New Generation Revenue Cycle Management: Real-time Data, Workflow Accountability & Reporting

WRS Health recently produced a white paper titled, “New Generation Revenue Cycle Management: Not Your Grandmother’s Billing System,” which examines new, cloud-based revenue cycle management tools for medical practices. Today, in the final installment of our six part blog series, we examine how the targeted information, including metrics and analytics, available through new generation RCM tools allow physicians to make better operating decisions.

Part 6

Mistakes or errors in the billing department cannot be identified instantaneously, but if you don’t have information readily available, you can’t act on it. During the course of normal billing and collections operations, a plethora of valuable information is collected, such as when a specific payer is consistently failing to make payments in line with the contractual obligations it has with a practice. Gleaning that information can help physicians to make better decisions dealing with that payer in the future. Analytics reports, such as data about payers, information about what services are bringing in the most revenue, and other important metrics can help practices improve their operations and profitability.

Workflow Accountability

A workflow that is infused with accountability promotes fast claim payment. Real time reporting means that your workflow is infused with financial accountability. When the billing, front desk activities and EMR are connected, the entire workflow is infused with financial accountability. Picture your Cloud EMR “talking” to your billing, and your billing “communicating” with your front desk. When all interactions are designed to capture data correctly and early and alert users when there may be an impact on billing, you maximize your ROI. A problem checker, infused with the workflow should be included with your EMR.

Advanced Analytics

Practices often don’t have the tools or the time to organize data and compile reports, so having advanced analytics and assistance with revenue forecasting from software that provides data reporting capabilities is a necessity. Physicians benefit from data that details how much revenue is collected in a given period. When using dynamic rules intelligence tools, physicians have a more accurate idea of the funds they expect to accrue in the future.

Reports that are set up automatically, as well as those that are customized to the data you need to help run your practice, will enable you to experience a level of control, planning and management that will help ensure the continuing financial success of your practice.

Real-Time Data

The best data reporting capabilities include reports that run automatically 24/7 in real time and provide your billing and accounts information as well as graphical trend reports that provide a quick snapshot of your financial health.

An RCM system should provide you and staff with a surplus of reports that run automatically to present you with the information you and your billing staff needs to ensure timely, correct and complete payments from your patients and insurers. Your system should provide you with the ability to view individual reports as well as a graphical trend for a quick snapshot. You shouldn’t have to stay up until midnight to run your reports. Reports should be set up one time and run automatically every 24 hours and they should be customized easily to fit your needs.

The experience of Derrick Wallace, M.D., of Ear Nose & Throat Solutions in Nutley, N.J., underscores how a higher level of control, planning and financial management can help ensure financial success. Dr. Wallace said, “That’s another feature that I wanted — to be able to track what’s happening. I can pull up a report while I am at home relaxing and see the status of my collections whenever I want to. I don’t have to call up a billing person to get a report or wait for some report at the end of the month. I can look at it whenever I want.”

One of the many benefits of the Billing Module is that it is helping Kuraoka Clinic to enjoy a low claim rejection rate. “The system gives you little warnings about certain issues that may have come up during note creation and fills in the blanks for the CPT codes for you. That makes it easier for you as far as decreasing the claim rejection rate. If there are any rejected claims, resending claims is super easy to do. The system pulls everything in and we just send it off and it goes to the clearinghouse and we’re done,” said Dr. Mark Rheaume, who runs the billing side of his wife’s Kuraoka Clinic in Georgia.

Noting that he recently transferred his day to day billing responsibilities to the practice’s Office Manager, Dr. Rheaume said, “My Office Manager was able to take over from me without having any real billing experience. She was trained by me and I think that with a lot of other systems it wouldn’t have been so easy to do. The system will automatically populate the CMS 1500 form based on what you did in your note and what orders you put in; so you don’t have to go and fill that in, which is the reason why the Office Manager is able to do it. It’s not like you have to read the note and try to figure out what you need to put in there. It will fill in the note for you.”

Customized Reports

Staying apprised of your company’s financial status is paramount to success, especially if you are expanding your practice. By using reports generated by his billing system, Dr. Mark Rheaume keeps abreast of practice finances at two locations in two states. “I really like the report generation. If there’s any information I need about how our company is doing compared to prior years, I can get it almost instantaneously,” said Dr. Rheaume.

Emphasizing how crucial it is to keep track of payments, Dr. Rheaume added, “You can tell who has paid and who hasn’t paid and try to figure out what’s going on. The collection reports show the amount of money collected, from whom and if it’s been applied yet. The claims filed reports show what claims are still pending and why they’re still pending. Are they pending because a patient hasn’t paid, the insurance hasn’t paid or because they haven’t been filed yet? You can keep track of where you are.”

Colleen Postma certified professional coder and practice manager of Ear, Nose & Throat Associates of Syracuse, N.Y., said, “The report shows your billing charges and the number of codes you billed. Ninety days in A/R (accounts receivable) — anything that’s been sitting out there over three months — really, really, really should be looked at. That’s money that’s out there that shouldn’t even be out there. You shouldn’t have a lot of money that’s still with an insurance company that’s out there over 90 days without some explanation. It could be lost revenue.“


The adoption and implementation of an integrated cloud-based EHR and billing system can be a daunting task, but with the selection of the proper tools it can be a solid win for the small medical practice.

David Frank, Office Manager of Franks Wellness Center in Seminole, Florida, could very well be called the poster child for maximizing a medical practice’s ROI. “We started using our new EMR with billing capabilities on May 1, 2012, and our revenue picked up at least 40% almost immediately. The Billing Module allows us to utilize the system more efficiently by posting payments and sending claims to the insurance companies on an immediate basis versus delaying it a week or more. There were a lot of things that weren’t previously being billed out. They were still sitting in queue,” said Frank.

With the healthcare landscape continually changing, time is of the essence in reassessing old business practices. New generation RCM allows you to examine all aspects of your billing and collections cycle and is optimized for performance improvement and automation opportunities. Your medical practice requires automation and integration to maximize billing and collections. The new billing paradigm has arrived. As we mentioned earlier… this is not your grandmother’s Billing System any more.