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Most medical practices are familiar with the use of Modifier 25 for separately billable evaluation and management (E/M) services performed during minor office procedures. While the use of billing Modifier 25 allows providers to be reimbursed for both the E/M service and the minor procedure, the medical necessity of the separately identifiable E/M service must be documented in the patient’s record.
New Requirements for Cigna Modifier 25 Policy
The phrase revenue cycle management (RCM) is a wide-ranging term that refers to the process of identifying, collecting, and managing revenue from patients. It encompasses everything from determining insurance eligibility to balancing patient accounts. For your healthcare facility to thrive financially, it’s essential to have an efficient RCM system in place
How RCM Healthcare Services Improve Financial Stability and Compliance
RCM best practices can protect your organization’s profitability and operational efficiency. By implementing these best practices, you can keep your revenue cycle billing on track, ensuring financial stability within your organization.
Optimizes Revenue
Optimizing revenue with RCM best practices means you can invest in better infrastructure, technology, and patient care. By minimizing claim denials and reducing reimbursement time, RCM ensures accurate coding, timely claims submission, and follow-up on unpaid or denied claims.
Improves Cash Flow
Improved cash flow directly leads to better service delivery and improved patient care. By making sure billing for patient services is done on time and accurately, RCM keeps the financial cycle running smoothly. When you submit claims promptly and accurately, you can reduce the time between providing services and getting paid. That means you can meet your financial obligations faster, such as paying staff salaries, buying new equipment, and keeping operations running.
Controls Costs
RCM best practices are designed to control costs by reducing administrative expenses, eliminating billing errors, and minimizing claim rework, saving you money and time. Effective RCM also helps you identify areas where expenses can be optimized and resources can be allocated more efficiently.
Ensures Compliance
RCM also plays a crucial role in ensuring your healthcare organization adheres to complex regulations and billing requirements. From government agencies to insurance companies, RCM professionals keep a watchful eye on the ever-changing landscape of healthcare regulations and codes to ensure compliance and minimize risks.
Data Analysis and Performance Monitoring
RCM also involves the collection and analysis of revenue, claims, and reimbursement data. By diving deep into the financial performance of your organization, RCM provides invaluable insights and identifies areas for improvement. With RCM, you can also spot bottlenecks and process inefficiencies that might be holding your organization back. That means more revenue-enhancing opportunities for you to capitalize on.
To maintain financial success, you also need to understand essential KPIs you should track to optimize your business operations.
How to Improve Revenue Cycle Management in Healthcare
Below are a few tips to improve revenue cycle management as a healthcare provider.
Update Processes Regularly
By using data analytics, you can gain a clear view of your revenue cycle management processes, track performance indicators, monitor payment delays, and keep an eye on the number of denials. That way, you can make adjustments and process improvements regularly.
Give Patients Multiple Ways to Pay
High deductibles and out-of-pocket expenses can be a barrier for patients who need medical care. To give your patients access to the care they need without financial stress, consider offering flexible payment options, such as monthly installments and a streamlined enrollment process.
Keep a Handle on Insurance Eligibility Verification
One of the most overlooked best practices is patient insurance verification. When new patients visit your facility, it’s essential to verify their insurance before providing any treatment. You can take it one step further with a solid follow-through plan to handle any prior authorizations promptly.
Quality Billing and Coding
High-quality billing and coding is crucial for preventing unnecessary denials. If you handle your billing and coding in house, it’s essential to make sure your staff members are consistently updated and trained on the latest changes in the industry. Keeping them educated will help you stay on top of your medical claims and prevent issues. If you’re not getting the results you expect from your in-house team, consider outsourcing your medical claims billing to a specialized company.
Practice Timely Denial Management and Follow Ups With AR
Denials result in lost revenue and come with a hefty price tag of $31.50 per denied claim. To tackle this issue head-on, it’s important to make follow-ups in accounts receivable a mandatory part of the administrative workflow. This ensures that denials don’t sit idle longer than necessary, preventing further financial losses and streamlining the revenue cycle.
Invest in Revenue Cycle Partners
Instead of struggling with a small team that lacks expertise and resources, imagine having access to a larger staff with specialized skills and advanced technology. Revenue partners specializing in healthcare services can handle every aspect of the revenue cycle from coding to patient scheduling, ensuring that not a single dollar goes unclaimed. By partnering with revenue specialists, you can streamline your processes, automate workflows, and seamlessly transition between digital assets and staff members, resulting in faster financial results and a more efficient patient experience.
Key Takeaways
By outsourcing RCM healthcare services, you can improve your financial stability and ensure compliance with ever-changing regulations.
Horizon Healthcare RCM helps healthcare organizations across the country identify, collect, and manage reimbursement. Our services improve your financial processes so you can keep providing top-quality care for your patients. Contact us today to learn more about how we can transform your reimbursement process and help your organization thrive.
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