Effective Coding, Billing and Collections in RCM

Revenue cycle management (RCM) is key for any organization, but it’s especially important for medical practices. These organizations are responsible for high-cost processes that can lead to exceptional losses without reimbursement or collections. Medical organizations need defined and accurate coding, billing and collections to stay afloat.

Challenges of Medical Coding and Billing

The world of medical coding and billing is complex — to say the least — and medical providers of all sizes face challenges when managing this side of RCM. The core hurdles in coding and billing include:

• Filing multiple claims: Many practices have a high volume of claims to file per week. Larger practices may see thousands of claims, and many of these organizations lack the automation and resources to keep up with these filing demands. As a result, employees fall behind on billing and coding requirements, reimbursements decrease or organizations lack the documentation to quantify these losses.
• Increased requirements: In recent years, insurance companies have continued to require more details in claims to verify reimbursement. These higher expectations for claims lead to even more bottlenecks alongside high claim volumes.
• Evolving regulations: Coding and billing regulations change frequently, especially for government programs like Medicaid and Medicare. Even with a robust billing team, it can be challenging to keep up with these regulations and file claims correctly throughout the year.
• Coding errors: Coding is a sensitive process, and the smallest typo can lead to a rejected claim. These small mistakes are quickly exacerbated by changing codes amidst evolving regulations. Human-driven coding processes often lack the precision to meet this strict environment.
• Technology demands: Most coding practices require electronic health records (EHR) that rely on highly trained professionals to use them effectively. Medical practices with enough resources may have computer-assisted coding (CAC) but need ongoing IT monitoring to ensure it functions. Between the human resources and technical needs, many practices feel challenged to keep pace.

Challenges of Medical Collections

On the other side of RCM is collections. Even if billing and coding processes operate smoothly, obtaining the revenue is a separate system. Some of the key challenges in this area include:

• Coding changes: Practices may be prepared to receive an expected reimbursement for a claim, but a coding change leads to a lower reimbursement. This adjustment causes incorrect projected revenue and leans on the patient to pay for the remainder.
• High deductibles: Insurance companies continue to raise deductibles, putting more financial responsibility on patients. Economic factors continue to increase the cost of living, which may make it challenging for many patients to cover medical bills.
• Employee requirements: Collections require follow-up with insurance companies and patients to ensure bills are paid, which demands more time from employees. Between sending out mail to making phone calls, practices may feel short-staffed in the wake of collection requirements.
• New regulations: New regulations like the No Surprises Act often demand adjustments from teams to ensure revenue collection is fair and legal for a client. In the case of the No Surprises Act, practices have to make up the difference if a bill ends up being higher than projected, ultimately affecting revenue for the facility.
• Lack of payment flexibility: As patients become increasingly responsible for covering their medical charges, they expect more ease in making payments, like online bill pay and Automated Clearing House (ACH) payments. Many facilities lack the financial infrastructure to meet these demands, and patient inconvenience reduces payments.

Resolving the Challenges of Coding, Billing and Collections for Medical Practices

With the many challenges medical practices face in coding, billing and collections, these care providers need a trusted solution for RCM. Partnering with an RCM expert can help your team effectively manage coding, billing and collections, even without the necessary in-house staff. Outsourcing revenue cycle management allows you to effectively handle back-office processes while supporting your patients.

The Benefits of an RCM Partner

Working with an RCM partner offers:

• Cost savings: Hiring an in-house team to support billing and collections may not be in your budget. Outsourcing is an excellent way to support your team for a lower cost.
• RCM expertise: A specialized RCM organization offers extensive experience and expertise in medical coding that can be challenging to find elsewhere. These focused skills and our access to financial resources improve accuracy.
• Greater efficiency: With a dedicated team for RCM, your team can focus on core competencies while accuracy improves for billing and collections. Ultimately, your practice becomes more efficient.
• Increased revenue: Improved accuracy in billing and coding increases reimbursements, while a defined collections process increases patient payments. Together, these factors improve revenue for your organization.

Partner With DME Service Solutions for Effective Medical Billing

DME Service Solutions specializes in RCM for healthcare organizations. With front- and back-office support, we improve your organization’s accuracy and timeliness for improved revenue. Explore our RCM solutions today, and get in touch with us to learn more!