Ohio family medicine providers (family practice) need to consistently stay ahead of shifting payment models, insurance changes and legislative updates. In addition, they must learn multiple software, systems and online portals. These systems range from electronic health records (EHRs), practice management (PM) tools, clearinghouses and billing system software.
In order to successfully navigate these requirements, family medical practices need billing solutions that simplify and streamline these required operations as well as other revenue cycle management (RCM) tasks. To accomplish this task, Ohio family medicine providers should use trustworthy and reliable partners who are familiar with state and federal mandates as well as insurance reimbursement practices.
Medical billing, or the more encompassing term of revenue cycle management, has become increasingly complex over the years for family medicine practitioners. This is due to payer required documentation review, reduced reimbursements as well as the growing list of required software and online systems. These requirements are a necessity if medical practices want to maintain their cash flow and get paid in a timely manner.
If family physicians want the business aspect of their run as smoothly as possible, it is often a wiser choice to outsource these billing and credentialing tasks.
The Business of Family Medical Practices:
The complex and time-consuming nature of revenue cycle management can leave many doctors feeling frustrated. Medical clinicians already have enough to focus upon. After all, they attended medical school in order to practice medicine, not business. Yet, for independent practices and smaller physician groups; trying to understand and maintain their revenue cycle is a struggle.
But, having a predictable and optimized revenue cycle is a great asset for any healthcare practice, whether large or small. A reliable medical billing system and efficient accounts receivable (AR) is no guarantee of success. However, if medical billing requirements and AR are disorganized, medical practices will struggle.
New RCM Trends:
Medical providers and other industry observers have noticed the changes that have occurred in the healthcare system. Insurance credentialing is challenging due to the fact that some insurance panels are sometimes closed. Other times, the contractual rate or fee schedule is lower than what was expected.
A greater amount of technical aptitude is required for medical office staff in order to stay up-to-date and in compliance. Understanding the technological tools that are required for the modern healthcare office is vital. The days of paper charts and submitting paper claims are long gone. Interoperability and data security are one of the main goals, with seamless integration between the various systems.
These technological requirements leave many smaller offices feeling unprepared for the demands of the modern healthcare system. Especially as larger companies move into the healthcare marketplace and put more pressure on small and independent providers.
Shifting insurance plans mean that patient behavior has also changed. Some healthcare providers may need to educate their patients about insurance plan details. Patients may have insurance coverage, but they are not always sure as to what treatments and procedures are included in their coverage.
Many primary care physicians have noticed that reimbursement patterns are now more drawn out. So during the first half of the calendar year, patient payments may fluctuate. This is because many patients have not yet met their deductible threshold for their insurance plan. Increasingly, some patients are struggling with these payments as high-deductible insurance plans become more common.
The Benefits of Reliable RCM:
A sound revenue cycle management service will reduce denied and rejected claims while smoothing out back-office billing inefficiencies. The goal is to reduce any potential problems that may occur during the medical billing process:
- Confusion or inefficiencies in understanding the status of submitted claims.
- Communication breakdowns between the insurance payer and medical office.
- Office clinicians feel overwhelmed with the management of credentialing data.
The goal is to have an integrated strategy the creates a team approach between the clinicians the medical billing/credentialing specialists. With this approach, information is less likely to be misplaced or lost. Ultimately this creates a better revenue cycle that provides greater financial stability over the long-term.
We provide revenue cycle management services for independent family medicine practices. Our services also include insurance credentialing assistance and online marketing. For additional questions about revenue cycle management, contact the staff at Advanced Billing & Consulting Services.