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Five Components of an Intelligent Physician Revenue Cycle Management System

Several physicians encounter a host of problems due to the consistently growing complexity of the physician revenue cycle management. Being a physician medical billing expert, I have also tackled those problems, and I can foresee new ones arise is going to take their place due to the coronavirus crisis. Therefore, in this article, I have enlisted five intelligent components that can help physicians to adopt smart physician billing solutions to optimize their revenue cycle.

Due to the public health emergency caused by the drastic spread of COVID-19 all across the globe. The healthcare environment has changed regarding every aspect. However ever-changing regulations are there but adopting value-based reimbursement (VBR) models is a major challenge.

Implementation of new payment models can more complicate revenue cycle activity and make it more difficult with additional quality reporting and other requirements. Additional operations of siloed workflow, data proliferation, disparate systems have significantly impacted the efficiency of the physician revenue cycle management negatively. New payment models have complicated revenue cycle activity, therefore it has become more challenging to achieve revenue integrity and financial stability.

1. USE THE RIGHT PHYSICIAN BILLING SOLUTION AT THE RIGHT TIME

Today’s environment requires sharpening strategies to ensure revenue integrity. Providers can’t deal with these complications while encountering the public health crisis. Therefore, they should outsource physician billing services to a professional medical billing company that can seamlessly manage revenue cycle operations with the use of their EMR and expert capabilities.

Also, it is essential to leverage complementary technologies with specific core expertise to improve physician revenue cycle management. However, for this sake, physicians would have to invest a significant capital amount and time in order to upgrade their existing systems and training their employees to enhance their core capabilities. Although, a medical billing company would monitor records in real-time enables timely auditing, coding adjustments, and case completion to reduce medical billing turnaround and reimbursement delays.

2. TAKE A SMART APPROACH TO USE TECHNOLOGY

Augmenting your core systems with complementary technologies or capabilities on a single, integrated platform makes it much convenient to support internal collaboration among different teams that contribute to your business. If you’d outsource physician billing services to create an integrated platform, then you speed up your physician revenue cycle management system to value. Physicians can seamlessly deploy additional expertise onto that platform instead of using multiple disparate tools.

A smart technology medical billing platform that crosses departmental silos, aware of artificial intelligence and other automation enables physicians’ business to proactively focus on the areas where their expertise has the most impact. Moreover, when deciding to outsource physician billing services, one expert team’s work will not get canceled out due to the contribution of another team.

Regardless of your business size, outsourcing physician billing services will add value to your physician revenue cycle management. It can provide a depth of specialized expertise that drives better documentation, coding, and real-time audit interaction. All these factors influence the performance of revenue cycle positively

3. COMPREHENSIVE AND ACCURATE DOCUMENTATION FOR CODING

Unfortunately, it seems the battle against claim denials is going to last forever in the healthcare space. You can’t overlook the importance of front-end data validation prior to coding to eliminate rework and inefficiency. However, the ability to ensure complete and accurate clinical documentation for every case will improve collection management and reduce the inefficiency of denials and rework.

Expand the scope of your CDI program with technology that uses clinical intelligence to drive concurrent documentation review for all payers. Getting it right up front contributes to accurate medical coding, reimbursement, and appropriate quality measures.

4. STAY CONNECTED WITH THE PAYERS

As long as payers and providers, and continue working at odds, the costly abundance of claim denials will continue with the flow. In a perfect world, both sides would join forces to find mutually beneficial solutions for claim errors, denials, and payment delays.

Imagine that you can save a huge amount by reducing administrative inefficiency alone. However, most of the physicians are not in that world. Therefore, it is important to make a proactive effort to understand the specifics of each player's contract and adjust your internal processes and technology rules accordingly. As operating margins get smaller, practitioners have no choice but to optimize the efficiency and accuracy of physicians’ revenue cycle management. Therefore, understanding and connecting with each payer is essential for physicians.

In this way, it increases the workload on the physician’s staff and they have to compromise their time in attending phone calls instead of delivering a quality patient experience. Hence, outsourcing physicians’ revenue cycle management would let physicians focus on their core capabilities i.e. patient care services. Working together would significantly contribute to the efforts to achieve business goals.

5. CONSOLIDATE, COLLABORATE AND COMMUNICATE

Industry pressures to improve performance are unrelenting, especially around smart solutions, innovation, and increasing both efficiency and the bottom line. Organizations are expected to improve these areas while, at the same time, enabling patient-centric operations. One way to achieve this is to leverage innovative, integrated tools to augment core systems and promote partnership, communication, and efficiency across multiple related disciplines.

Consider clinical documentation, coding, and auditing. Numerous departments need pieces of that information for different reasons, including utilization review, medical necessity determinations, chart audits, and quality monitoring, in addition to bill preparation. A single repository containing up-to-date data in a real-time view driven by supporting workflow, rules, and alerts provide consistent and reliable information when and where it’s needed.

As patient care becomes more complex, so does the middle revenue cycle. Seek solutions that will simplify and manage the complexity in an administratively efficient way. Consider your prospective vendor’s core competencies when evaluating solutions and look for integration and intelligent automation that will add the most value to your organization.

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