New Generation Revenue Cycle Management: This is Not Your Grandmother’s Billing System

So much of our lives have moved online. The immediate access, technical innovation and lightning speed of the web has changed life as we know it. We expect to do things faster, easier and smarter. The old medical office billing paradigm has also undergone a striking metamorphosis with the advent of state-of-the-art, cloud-based, integrated Electronic Medical Record (EMR) and Revenue Cycle Management (RCM) solutions. The billing office of 2013 bears no resemblance to the billing office of yesteryear. Internet connectivity and high-speed broadband access has ushered in a new age in RCM.

Highly automated, optimized processes have replaced outdated methods for maximizing Return on Investment (ROI). The new generation of RCM solutions are delivered on cloud-based platforms with a seamlessly, integrated workflow. This is the wave of the future. Everything leads to RCM optimization. Today, we launch a six part blog series dedicated to examining the critical elements to be examined in the quest to increase RCM ROI. This blog series, based on our white paper, “New Generation Cycle Management: Not Your Grandmother’s Billing System,” is meant to get you up to speed quickly, so that you can prepare to maximize your ROI for medical billing solutions.

Part 1

RCM is the process of managing claims, payments and reporting on revenue generation. It entails using technology to keep track of the claims process at every point of the cycle, enabling practice owners and RCM personnel to actively manage the process and address any issues that arise. This enables a steady stream of revenue.

Multiple factors in the healthcare industry, and the overall economy have squeezed the medical practice bottom line. These include increased deductibles; dramatic rise in unemployed/ uninsured patients; and a wave of government regulations, such as Meaningful Use ICD-10, PQRI, and 5010. The outcome is decreased ROI, forcing medical practices to find ways to increase revenue and optimize efficiency… just to break even. The good news is that a new generation of integrated, cloud-based, RCM systems offer you alternatives that can be far more than just a neutralizing solution. This new breed of medical billing software coupled with best processes and solutions present increased efficiency and optimized business processes that actually help you increase ROI and come out ahead of the game.

New Generation Revenue Cycle Management: Faster Payments

For most small businesses, including medical practices, cash flow is the life blood of their thriving enterprise. Medical practice owners want and need to get paid faster. The speed of charting, coding and generating is key to this factor.

Automatic Claim Generation

Edward Rossi, M.D., of Your Hometown Pediatrician in Warwick, N.Y. is also maximizing his billing returns with web-enabled billing software. “When you do your note and sign off on your note, a claim is created, the system picks up everything off of the note and puts it on the CMS 1500 form for you. You or your biller can go over that and if there is a question, they can go back to the note and see, ‘This is a 15-month checkup and normally this vaccine is done, let me go back to the note and see why it wasn’t showing up.’ The note will say that the child has a fever and a cold, and the biller will say, ‘Okay I don’t need to put this on here.’ The whole thing is seamless. We are getting paid much faster,” said Dr. Rossi.

The experience of Gail Wyatt, Office Manager of Trilogy Women’s Health in Grapevine, Texas underscores how a new OB/GYN practice can use an integrated Cloud  EMR with billing to get paid quickly. Wyatt said, “Dr. Robert is a solo practitioner who works with a Nurse Practitioner. At the end of the day, it’s all about our billing. Our billing is being done properly and quickly. You have to get paid so that you can keep your lifeline. Having gone on our own, we have more bills to pay. We are able to pay these bills. We would not be able to do that if we did not have a good billing system in place. We’ve been very pleased that the claims are getting paid in a timely manner. Our claims are getting paid very quickly. We are typically paid in two weeks. That’s phenomenal.”

When Gregory Nestor left a large clinic to open his own primary care practice in 1987 he hired an outside billing company, but later found out that they weren’t doing a stellar job of collecting the amount that he was owed. Chantel Jackson, practice manager said, “Through hard lessons, we learned they were not collecting even 50% of what we were sending over. Now, our turnaround time on our claims is the best part. We generally get paid within seven days. Our Cloud EMR system has helped us 100%. As far as the billing goes, processing the claims has been the easiest thing. It pulls out your error and acknowledges it to you before it even gets to the point of the clearinghouse. It scrubs the claim prior to sending it out, which is a big help. It’s a really huge feature. For instance, if we accidentally put in a double diagnosis on line 2 and line 1 or if we put a diagnosis that doesn’t cover a certain procedure, the system won’t let us go any further until we correct it. Billing mistakes don’t occur any more. We learned our lesson. Compared to the billing we had before, our system generally saves us two to three hours a day.”

Transmit Claims Sooner

With a truly integrated, cloud-based billing system, surgeons are able to bill while they are still in the operating room. Consider the case of Victor Kareh, M.D., of Texas-based neurosurgery practice Brain & Spine Surgery Associates. “When I do an operation and I finish my surgery in the operating room, I can dictate my case for the hospital. On the same computer that I use to do my hospital charting, I open another window and I enter the surgery codes. The information is already in my office and they can do the billing five minutes after I do my surgery,” said Dr. Kareh.

Dr. Blythe added that his billing for in office patient visits benefits from instant connectivity of a web, as well. “Before a patient reaches our front desk office, visit claims are already at the insurer. We got really efficient at that. Most patients’ claims are in real time as opposed to the old days where we created a super bill and a front desk person would enter those claims and then we would review them at night, batch them and they’d go out the next day. The surgery charges would go out a week later after we had a chance to code them. Now it’s all instantaneous.”

Track Payments Quicker

Electronic Remittance Advice (ERA) is another time-saving, cloud-based RCM tool that makes sure your claims are being paid promptly. An ERA is a standard report that can be read by a computer system detailing payments made. Choosing a system that accepts ERAs allows practices to cross-examine those payment details against payer contracts, so the practice can ensure it is collecting according to its contracts.

Tennessee-based Faith Family Medical’s Office Manager Marie Burriss revealed, “We can go into the system when we get those checks and automatically deposit them and then we’ve already posted those adjustments to the claims. A lot of the insurances automatically go through their Explanation of Benefits (EOB). Our cloud-based system goes into our ERA. We can go ahead and get those adjustments made and bill the patient for their deductible or their copay if they didn’t pay that when they were seen. That’s beneficial to the practice, especially with the 90- day collections window that we have.”

Post Payments Automatically

Posting checks manually is part of the old billing paradigm with the advent of Automatic Payment Posting featured on many of the new cloud-based, RCM systems. “What used to take an hour, now takes 10 minutes,” said Desiree Centalonza Florida-based Park Medical Center’s Billing Specialist. She explained, “Instead of having to manually post the entire check, depending on whether it’s commercial or Medicare, nine times out of 10 all I do is just enter the contracts and I’m done with that particular post. Before we used this system, we had to do everything. Now, it’s just a click away from being done, it’s great. Because we are receiving remittances electronically, the turnaround is just between 14 and 18 calendar days. Because we are filing daily versus using a service that files weekly, we have a daily cash flow versus a weekly to biweekly cash flow.”

Since electronic payment occurs on average two weeks sooner than paper checks, this has a dramatic positive impact on your cash flow. In addition, automated processes free up your billing staff to concentrate higher level billing functions.