Here’s How You Can Understand and Improve Your Revenue Cycle Management
Health care industry is faced with several challenges such as tightening margins and declining cash flows. What with increasing bad debts, maintaining a steady stream of income has become one of the primary concerns of medical practices and physicians!
Vital Role played by Revenue Cycle Management (RCM) in Medical Practices
Properly managing the revenue cycle of your practice is the foundation upon which financial stability is built. RCM is considered one of the crucial factors that determine the financial well-being of practices. With practitioners being trained to manage patients’ health and being occupied most of the time in treating patients, there is no wonder they lack the financial background essential for managing RCM efficiently. On the other hand, rising costs and demands necessitate greater emphasis on productivity and waste reduction – here’s where the need for effective RCM is felt.
Beginning at the time a patient schedules a visit and extending till you obtain reimbursement for services provided, revenue cycle process needs to be managed efficiently. Including several components that may complicate the entire process, it requires building business side of the practice and improving effectiveness in order to boost profitability and revenue of the practice.
Ways of Improving RCM
Coding & Denial Management
o Accurate coding is essential to avoid denials and delayed reimbursements – it is necessary to avoid claim resubmission and appeals process as far as possible
Right Collection Process
o Although every practice will have its own collection process in place, it is necessary to explore better and more effective processes that facilitate collection from insurance providers and patients – it is essential to have a cohesive collection strategy that is measurable
Front office staff
o Office staff must be capable of running your practice efficiently-practices need to work out the costs of internal billing staff and check whether they are within allowable limits-cost of outsourcing must be compared
Audit & Compliance
o Practices must have proper programs in place for determining whether procedures and policies are being followed -compliance needs must be properly adhered to
Significance of Taking the Right Steps
Healthcare sector is constantly evolving; technological advancements and innovations are on the rise. Not to mention the frequent barrage of payor and governmental regulations. It is imperative to take the right steps toward understanding and enhancing RCM. Outsourcing proves to be most efficient choice for several busy practices with resource constraints.
Numinatrans has been providing effective and reliable medical billing services to health care facilities and physician practices since more than a decade. You may contact us for improving your practice RCM. Visit us on https://www.numinatrans.com/
What is Needed and What is at Stake with the new Payment Reform of MACRA
The Sustainable Growth Rate (SGR) system that had been used for payment toward physician services in Medicare has been repealed by The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. Although considered conceptually sound, a large portion of final legislative language is supposed to be vague and complex. Its success or failure depends on the decisions related to implementation of the law.
MACRA Basics
The Centers for Medicare and Medicaid Services (CMS) has released a 962-page proposed rule related to the implementation of MACRA’s key provisions. Although some adjustments have been made based on input from stakeholders, there is much work yet to be done. Major areas of concern need to be addressed in the final rule. Care has to be taken to ensure that necessary infrastructure is in place in support of the legislation.
Payment Reform under the new Act
Two different tracks of physician payment in Medicare have been established by MACRA. The first one is the Merit-Based Incentive Payment System (MIPS) and the other, Alternative Payment Models (APMs). Quality Payment Program (QPP) happens to be an amalgamation of these two. However, option to choosing one of these may not be offered to a majority of physicians in the immediate future.
MIPS
Having been ridden with substantial reporting burden, MIPS may not be attractive over the next decade. This will be more so in the case of small practices that are likely to experience substantial cuts on reimbursement.
Burdens if MIPS
Drop in Reimbursement: Those who opt for MIPS will be average in performance scores, will find their inflation-corrected Medicare Reimbursements declining roughly by 18% over the next decade. Small practices operating with narrow financial margins may find their fees being reduced by 20%.
Lack of Equity: Apart from budget neutrality conformation, not much about payment adjustments is equitable in MIPS.
More administrative burden: MIPS being a complex Pay-for-performance program has substantial administrative burden. There is not much evidence to prove that significant improvements in quality of care can be achieved by pay-for-performance programs
APMs
Providers who wish to avoid the burdens of MIPS can do so by participating in advanced APM. Clinicians who have enough share of revenue from one or more APMs are eligible for 5% incentive payment from 2019 through 2024.
The objectives of MACRA – repealing the SGR, stabilizing physician payments, and fostering meaningful payment reform are agreeable. However, the situation created by the final legislative language makes MIPS becoming increasingly untenable for a huge number of providers. They may also be left with nowhere else to go by the scarcity of available APMs.