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The Healthcare Revenue Cycle Management Organizations Need Now

Sep 21, 2022 10:40:31 AM / by Altruis

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: Learn about the medical billing services and healthcare revenue cycle management organizations need to succeed.

Bad debt is a huge hassle for healthcare organizations. When insurance companies and patients don’t pay for long periods, the debt eventually becomes unrecoverable.

This leads to decreased revenue and decreased profitability. However, bad debt write-offs aren’t inevitable, with healthcare revenue cycle management, organizations can maintain their financial stability. Below are some of the best revenue management service options.

 

Advisory Services

Every healthcare provider is unique and has its own challenges. Effective revenue cycle management starts with an examination of the current state of things, plus potential future impacts.

This is why advisory services involve a personalized consultation and financial review. The advisor looks for ways to optimize your revenue cycle. 

Typically, advisory services make a long-term positive impact on your organization plus an immediate impact on your monthly financial status. This service includes reimbursements, eligibility, credentialing, education, training, and more.

 

Provider Credentialing

Proper credentialing ensures providers are qualified to receive payments from insurance providers and agencies like Medicare and Medicaid. Because any error can lead to a payment denial, the process takes careful management. 

According to the Medical Group Management Association (MGMA), more than 50% of all providers have seen an increase in credentialing-related denials in the past year. The problem is predicted to become even worse over time as the American healthcare system grows increasingly complex and arduous.

One of the best ways to streamline credentialing is by engaging in proactive licensure management. This strategy ensures all of a healthcare organization’s providers are fully credentialed for all relevant services, preventing delays and denials.

 

Medical Coding

How is your organization handling medical coding? Coding-related denials are rampant in the healthcare industry, but your organization doesn’t have to endure endless medical coding errors.

A medical coding service provides coding reviews and corrections before submission to the appropriate payor. This avoids denials based on coding and sets the stage for a more proactive and profitable healthcare revenue cycle.

 

Medical Billing

For decades, medical billing was an arduous process only slightly alleviated by digital processes. Today, a revolution is happening in medical billing due to robust new digital platforms and billing partners who can provide complete technology-enabled service.

This means your organization has fully digital, end-to-end streamlined medical billing without the kinds of errors, redundancies, and slowdowns that used to hamper the process. Modern medical billing is also technology agnostic, meaning it doesn’t matter what types of devices or setup your organization uses. 

 

RetroPay™

One of the more commonly misunderstood aspects of healthcare revenue cycle management is retroactive coverage. Many uninsured self-pay and charity-care patients eventually become eligible for Medicaid or other coverage after the date of service.

Altruis research shows that the typical healthcare organization has 10% to 25% of patients who qualify for coverage after the time of service. Imagine adding that 10% to 25% back to your A/R billing. It could make a huge impact!

RetroPayTM looks backward into your accounts to see which patient charges weren’t originally covered but would be covered now. This ensures your organization fully captures available covered reimbursements and maximizes receivables.

Keep in mind that these amounts are recovered from insurance, not from patients. This means there is no negative impact on healthcare customers and is essentially a win-win for both the patient and the provider.

Successful Revenue Cycle Management

When healthcare organizations have implemented the services listed above, they’ve seen impressive results. Here are a couple of examples of positive outcomes from using Altruis services.

Covid Vaccination Billing Project:

  • A California community health center had a backlog of 50,000 vaccination claims. 
  • Within a month, we cleared the backlog and began handling 28,000 claims per week.
  • Ultimately billing out over 500,000 claims for an organization and augmenting their existing staff. 

Full RCM Services

  • They achieved a 98% clean claim rate after reaching a steady state.
  • Revenue increased 56% in the 1st year.
  • The gross collection rate improved from 43% to 57%.
  • Their outstanding accounts receivable reduced from $4 million to $1.2 million.
  • Their A/R cycle shortened from 156.4 days to 34.9 days.

Altruis is an example of a best-in-class medical billing and healthcare revenue cycle management service. It’s much more than a platform because it forges healthcare partnerships to custom-match services to needs. This accelerates reimbursements and minimizes bad debt. 

To learn more about smart revenue cycle management for successful healthcare organizations, connect with Altruis.

 

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Topics: Revenue Cycle Management

Altruis

Written by Altruis

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