Marcy Marquis, CRCP-P, maxRTE Client Services Manager
Revenue cycle management (RCM) is essential for keeping medical practices and hospitals fiscally healthy. Billing is a complicated process filled with delays and many opportunities for things to go wrong (coding errors, rejections, uncollectible balances). Following up with insurance companies and patients regarding denied or unpaid claims can eat up resources as balances erode the bottom line.
Handling billing in-house or outsourcing each has its advantages and disadvantages:
In-house billing is cheaper and provides more control. However, small practice staff wears many hats that take attention away from time-consuming, complex RCM, which could lead to losing a substantial amount of money.
Outsourcing billing and RCMalleviates staff burden and increases collection rate and speed by reducing rejections and denials. In addition, these companies usually provide on-demand reports about day-to-day finances. However, it is a more costly route, with charges based on a percentage of collections or subscription fee.
Guidelines for choosing a trusted billing service
Outsourcing has far-reaching financial and legal implications that are critical to financial success, causing some providers to think long and hard about outsourcing RCM. However, should you choose to outsource, here are a few things to keep in mind:
Practice management software
You should look for a firm using reputable, flexible software from a provider that charges a flat fee for the most economical advantage. Make sure it is available to providers as well in case you decider later to bring these activities in-house. Questions to ask:
Most companies charge a percentage of monthly revenue as payment—usually between 3-9 percent of net collections. Here are key cost questions:
Services often offer more than scrutinizing claims for errors before processing them and following up with the insurance company to ensure claims are accepted. Nail down offering specifics:
Open lines of communication can mean the difference between a breakdown in the billing department and a boost to your bottom line:
You’ll want to be sure the service is willing to stay engaged with your patients about what they owe:
You’ll want to understand the service’s IT arrangement:
maxRTE has been helping healthcare providers shorten the revenue cycle for more than 20 years. With maxRTE, just one click validates plan-specific benefit data such as patient coverage effective dates, co-pays and deductible information. Visit maxrte.comfor your free web demo.