There is a lot to consider with the decision to outsource billing. Revenue cycle management (RCM) is far more than just filing a claim. The process starts with claim evaluation to reduce the chances of denial, continues with correct claim filing, and concludes with payment processing. The most important job of an RCM specialist is making sure every claim is paid to the fullest extent possible.
Let’s look at the pros and cons of remote billing—consider them all!
The advantages
• Expertise: Remote billing agents should have years of experience—in eye care.
• Efficiency and focus: Remote billing agents manage the RCM process. They are not distracted by the other office operations, patients or other employees.
• Rapid payment: Claims filed accurately and quickly mean you get your money fast.
• Stability: There’s no “downtime” for insurance processing.
• Cost: Outsourcing your RCM should save you money.
Potential detours
• Perceived lack of control: What’s going on? With the right communication protocols, this should never be an issue.
• Change in systems: RCM companies should require secure communication processes, unrestricted access to high-speed computers in your office, a robust electronic health records system and use of a proven clearinghouse. Extensive HIPAA compliance is essential. These changes may have some front-end costs.
• Staff sabotage: This is the most common cause of failure in outsourcing. Staff members may feel their jobs are in jeopardy, don’t like change, feel they need to protect the doctor from “these strangers” or simply do not like the decision.
Thinking about outsourcing? Here’s what to look for in a RCM company.
• Experience: Find someone experienced in eye care billing.
• Access: Ensure that a company assigns you to one individual to handle your account, not a team of people pointing fingers.
• Size: If the company is one person or has few billing specialists, you may experience the same issues with instability you have with an in-house biller.
• Fees: Determine that the RCM company charges based on monies received; you don’t pay them unless money is going into the bank.
• Claim control: Do they adjust or change procedures, diagnoses or medical records without approval from the attending physician? All of these liberties should not be granted to anyone except the doctor.
• Services: What services are included? The RCM process should cover start to finish. Some companies may offer additional services such as credentialing or patient billing but these processes are handled easily in-house and typically come with a significantly higher fee.
• Outsourcing: RCM management services are in high demand so many companies are outsourcing business to offshore agents. Consider expertise, access and communication problems that may be associated with this outsourcing.
Outsourcing can be an excellent decision for many practices. A good rule to follow: “Concentrate on your expertise and outsource the rest.”
Learn more at www.practicecompliancesolutions.com or call 844.626.6579.
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