Many dramatic things can happen on a boat—a major wind or rain storm, an equipment malfunction, an illness affecting the crew. But perhaps the most dangerous occurrence at sea is a leak so slow that it’s not noticed until a significant amount of water has entered the vessel.
The same thing is true for a medical practice. Major conflicts and crises get dealt with immediately while slow, persistent revenue leaks go unplugged.
Two things are needed to rectify the situation and get your practice back on course: a person in charge of maximizing each revenue point and the high-quality data he/she needs to find and fix the holes. In other words, the person in charge of your finances needs revenue cycle management software (RCM). It provides a view of the entire patient-to-pay cycle, which includes eligibility checking, co-pay collection, coding, billing, denials management, collections, and fraud prevention.
The insights provided by robust, integrated revenue cycle management software allow your practice manager or financial manager to act less like a bookkeeper and more like a CFO. Imagine someone in your practice armed with the data to control every facet of profitability, including overhead, payer contracts, claim errors, accounts receivable levels, and cash flow.
Here are some examples of events RCM software can alert your practice to before they happen or soon afterward:
- A patient was checked in but eligibility was not checked
- A co-pay or patient pay was not collected
- An appointment was canceled or missed
- An unauthorized visit or procedure is about to occur
- A patient was seen but the encounter was not billed
- A bill was not filed within the required time period
- A denial or unpaid claim was not followed up on
- Accounts receivable levels are higher than normal for your practice
- Collections levels are below your pre-set threshold
- An employee is not as productive as in the past
Two more important factors are contributing to the growing need for RCM software. First, the ICD-10 transition scheduled to take place next fall will greatly impact your practice’s revenue cycle and cash flow. Those who prepare now by shoring up documentation processes and ensuring they have tight revenue controls in place will fare much better than those who do not. Second, as healthcare reform continues to change the relationship between patients, providers, and patients, solid revenue cycle management may become the factor that determines whether your practice will sink or swim.