A hospital could be offering the best patient services and helping people get better every day. However, if bills are not collected timely and in full, the hospital will struggle to survive over time. As a medical practitioner, you are entitled to be paid for your services. Your medical billing and coding team needs to be on its toes, making sure services are billed right and sent to the payer (insurance provider, in most cases) on time.
An analysis conducted by Crowe Horwath a few years back mentioned that delayed collections or ineffective collections that lead to claims denials or adjustments can lead to a 1.9% decrease in the healthcare provider’s net revenue. For a large organization, this value could be devastating. With your existing work model and without any aggressive growth strategies, you could increase your revenue by just making collections more effective.
Here is where RCM technologies come to help. Technology is already seeing a profound impact on most areas of healthcare and revolutionizing the backend processes is something healthcare providers should not miss. You could be a part of a large hospital or running your private practice. Either way, the below four RCM tech drivers can instantly leverage your collections and improve revenue for your practice. Talk to your medical billing and coding team to see if they are implementing these in their RCM processes.
Automation is everywhere. In fact, automation is what geared the industrial revolution and continues to fuel most industries these days. As a healthcare practitioner, your back-end medical billing and coding team needs to adapt to automation effectively too. Automation helps quicken most RCM processes and brings down the risk of human errors. Here are a few ways automation can help better the existing RCM processes.
Automating eligibility verification – This will help healthcare providers quickly understand patients’ eligibility statuses for payouts and then proceed accordingly. This can even be done in advance before the patient’s visit.
Getting pre-authorization – Based on the eligibility verification, RCM tools can go ahead and send in pre-authorization requests. This can prevent the problems of pre-authorization requests.
Obtaining claims data – Such RCM tools can get claims data automatically from the payer website without your medical billing and coding team having to intervene.
Quick payment posting – With an automated RCM tool, your ERNs will be pulled in automatically multiple times in a day and payments will be auto-posted to these claims. This way, your team can avoid several hours of manual posting.
One of the top reasons why a claim could end up being denied or delayed is inaccurate coding. A coder can never relax. The smallest error in picking up the right modifier or neglecting/exaggerating a service provided can end up causing rejections or revenue dips.
While you can have the best of the medical billing and coding team working for you, having the technology to back them up is going to bring drastically positive changes to the efficiency of the team. Take Quintessence’s Codessence for instance. This is our ML-based coding tool that supports coders in every step of the coding process. The tool ensures coders don’t have to guess while coding and this improves the quality of codes churned out.
Using Codessence, your team can move bills from encounter to claim in less than 24 hours. Isn’t that impressive? Because Codessence is an ML tool, it learns with every code generated. With time, the tool can gently nudge your coders to improve their skills and quickly point out when there is an error. If you have specific guidelines and mandate requirements, the tool can be tweaked to include all that too so that it exactly fits your needs.
Artificial Intelligence could be the strategic advantage that your practice has always needed. When technology becomes intelligent, it completely changes the productivity landscape and that is what AI-based RCM tools do for your business.
There are so many ways AI assists healthcare RCM. Some proven benefits are:
Quintessence’s medical billing and coding experts enjoy working with Reimburssence, our AI-based reimbursement tool that makes reimbursements strategic, planned and inclined towards closure.
Reimburssence has a direct positive impact on collections. The AR Assist tool assists billers take the right decision on a claim. This AI tool is continuously learning and that means, over time, it understands patterns and pushes most claims towards closure confidently and quickly. As a client, you would want the good touches to increase and Reimburssence measures touches to closure constantly and help your billers pick up the right claims at the right time and push them forward for payments.
Now, what does this mean? Documentation is a basic process that needs to happen before you can bill a payer correctly. Documentation needs to happen from the minute a patient schedules an appointment. Now, many a time, the medical billing and coding team doesn’t receive comprehensive information on the type of service provided and this means there could be a chance of overcharging or undercharging the payer. This may lead to claim rejections.
You can prevent this by ensuring the right information flows from the front-end team to the backend. There are tools specifically created for this purpose. Our Doctor’s Portal is a free, inclusive tool that all our clients get to use. With this tool, an RCM expert will be able to raise a ticket if they feel there is additional information required from the healthcare provider. You will get a notification about the issue and you can respond back, helping them close claims quickly.
This way, your AR cycle reduces and bills move towards closure quickly without information bottlenecks.
How does your billing team handle such queries? If they are sending emails back and forth, waiting for answers for days together, then you definitely need a tool like the Doctor’s Portal to get information flowing seamlessly.
Technology is going to be the driver for the RCM industry and in a sector like healthcare where the medical billing and coding experts are always chasing behind deadlines, pushing encounters to claims, and are pressurized by changing regulations, technology can be the difference between a successful and struggling healthcare business. If you think your backend billing and coding process needs a makeover, then our solutions could be just what you need.
Quintessence is backed with the perfect mix of human expertise and cutting-edge technology and can help create a sustainable, efficient, and tight RCM flow that will help improve collections and increase revenues.