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New Generation Revenue Cycle Management: Hold Patients Financially Responsible

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 part three of our six part blog series, we examine how new generation RCM tools can help ensure patients complete their payments in full and in a timely manner.

Part 3

Although most physicians’ top priority is spending time treating patients, they must also concentrate on the task of collecting payments from them. “Patient collections is the latest cause of practice administrators’ sleepless nights,” said the author of an article in Medical Group Management Association’s (MGMA) Connexion Magazine, because “practices have to concern themselves with collecting $1 of every $4 directly from patients.” The article also points to “MGMA Practice Perspectives on Patient Payments” research recently conducted with Visa Inc., in which participating practices reported that 23.2% of total patient services revenue is attributed to collections from patients.

With patient payments assuming a larger portion of the total reimbursement for services rendered, having a system in place that helps ensure that patients are held financially responsible while preserving your patient relationships is more important than ever.

Automatic Eligibility Checking

Automation is a big part of the new paradigm, especially when it comes to holding patients financially responsible for services rendered. A state-of-the-art RCM system will allow automated queries with the insurance company to immediately provide your front desk with the correct copayment, deductible amount and coinsurance when a patient checks in or out. The correct balance, including outstanding balances, can be collected from patients when they are in the office. When all of this information gathering automatically happens at the front desk, it frees the billing office from the burden of manually confirming eligibility. In addition, when information is available at the front desk, you don’t have to wait until the end of the billing cycle to make patients responsible for their visits.

It is critical that practices be informed when a patient’s insurance has changed. Postma said. “Sometimes patients don’t willingly tell you that they changed insurance. We have Real Time eligibility capability, which is wonderful. That means we can ask the patient, did you get new insurance this month, because the system is telling us and it is able to go right into their insurance company’s Web site.”

Integrated Collection Services

No doubt about it. You want to collect payments, but you don’t want to rock the boat with patients and let collections jeopardize your patient relationships. If collections do become necessary, it’s important that your patients are billed the correct amount in a timely fashion. Your patient relationships are crucial for your success and a cloud-based EHR and Practice Management system helps preserve this relationship with a professional, accurate and timely patient payment workflow.

It’s critical that billing is not separated from registration, charting, scheduling, patient portal, and other functions in the system. All interactions should be designed to capture data correctly and early as well as to alert users when there may be an impact on billing. From alerting surgeons to the global period of encounters, to ensuring payment for immunization administration, to notifying the front desk as to the status of the patient balance, helps ensure that all parties are held financially accountable at the earliest point possible and that problems are detected before they happen.