Having multiple vendors is a trend that has been picked up in most industries. The medical billing and coding services industry has been a cautious observer so far, but is slowly warming up to this idea too. Outsourcing and offshoring are not new ideas to healthcare service providers. In fact, most RCM service providers started outsourcing some or most of their processes from the 1990s. While outsourcing and offshoring were common, using multiple vendors was not, during that period. It was only after 2003 that service providers started cautiously approaching the idea of hiring more than one vendor to handle their billing and coding processes.
According to Industry research, one in seven claims get denied, amounting to over 200 million rejections each day. Did you know that 85% of claim denials can be resolved? The Process of sending appeals is very crucial for Revenue cycle management services. Appealing refers to the process of requesting the payer to review their decision against the denial of the claim. It is important to know that appeals can be made both by the patient and by the provider to the payer. The majority of the appeals are dealt with by the provider’s office, as the revenue cycle is handled by them.
Revenue Cycle Management (RCM) is the backbone of all medical billing and coding companies. It is, in fact, the functional core that helps handle all processes, starting from making a patient appointment to managing appeals and reimbursements. The right RCM process increases revenue and profitability, improves reimbursement rates, and brings down the rate of bad touches. Some companies handle their RCM processes in-house, while a majority of them outsource the same. Either way, how does one measure the health of the current RCM process?