Revenue Cycle Management - Out Of Network
BIS provides integrated revenue cycle management services for out-of-network providers by negotiating settlements to claims generated outside of the patient’s coverage network and working towards converting payors to in-network wherever possible.
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Intro
Health services play a very dominant and significant role in saving lives and treating patients. While providing quality health care is the goal of any healthcare services, staying financially strong with a healthy Revenue Cycle is the key for them to thrive in practice. Hence it is imperative to have an efficient healthcare revenue cycle management services.
Healthcare Revenue Cycle Process
Healthcare Financial Management Association defines the Healthcare Revenue Cycle as the set of all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue. The entire process is complex and includes multiple factors. RCM in healthcare typically starts with the first step of the patient making an appointment with the hospital and ends when all claims are processed, paid, collected, and settled. This covers the hospital’s entire revenue cycle. A healthy revenue cycle should ensure all services provided to the patients are billed to the payer (either the insurance company or the patient, based on eligibility) and the payment is collected for the same. The Various Components in This Revenue Cycle Management Are:
Challenges In Revenue Cycle Management In Healthcare
While the healthcare cycle process appears to be simple and linear, it is interrupted by series of challenges at various stages from scheduling to collection of payments. Claims can often be denied due to various reasons by insurance providers. This could be due to hitches faced at any stage of the process.
While there is a minimum time frame for a claim to be processed, it is also quite normal that some claims are shuttled between providers and payers over several weeks until the differences are resolved. Since most patients may not be in a situation to pay and clear their bills immediately, the revenue cycle proceeding doesn’t always run as smoothly as expected. In a recent study, 70 percent of providers say that it takes a month or a more to receive the complete payment from patients.
Claims tracking is another tailback to the revenue cycle management and it must be closely monitored throughout the entire cycle. Issues that are not resolved immediately could result in revenue loss to the providers.
Lack of education and training for the resources could affect the payment collection. Human errors are the weakest link in the RCM operation. Such errors occur majorly while verifying insurance eligibility and coding and failing to collect and key-in all required information into a patient’s record.
Need For Professional Revenue Cycle Management Company
With many challenges in the healthcare revenue cycle process, role of healthcare companies becomes significant. Managing it through medical billing professionals makes the job easier, faster and cost efficient. RCM companies take care of the end-to-end process of revenue cycle billing. Hence, healthcare providers can focus on rendering quality service to their patients.
An efficient healthcare with its well-designed system ensures the billed amount is paid completely and promptly to the providers. With their expertise and qualified resources, they improve claim approvals, reduce denials, and effectively track claims for prompt payment.
Why Choose Business Integrity Services?
Business Integrity Services offers end-to-end integrated revenue cycle management services. With our 100+ years of combined experience, we ensure highest customer satisfaction levels. We leverage our state-of-the-art technology to help accelerate your revenue growth. With our expertise, we manage your hospital revenue cycle at lower cost and reduced turnaround time. We analyse areas of revenue loss, reduce denials, and increase revenue.
An efficient healthcare revenue cycle company with its well-designed system ensures the billed amount is paid completely and promptly to the providers. With their expertise and qualified resources, they improve claim approvals, reduce denials, and effectively track claims for prompt payment.
Key Differentiators In Healthcare Revenue Cycle Management Services:
- Optimize time by automating routines like appointment/payment reminder and reaching out to insurers for claim denial.
- Determining a patient’s insurance status and copay requirement.
- Analyzing and providing insights on claim denials.
- Ensuring proper reimbursement for Medicare patients.
- Include error detection to assist in correcting and tracking unpaid claims.
- Review revenue shortfalls.
- Improve TAT of overall revenue cycle billing.