Revenue Cycle Management Services: Turning Patient Care Into Predictable Revenue

The true meaning of Revenue Cycle Management (RCM).

When you're thinking of RCM, you can't help but think of just bills but this is an understatement. Revenue is the process that begins long before a claim is submitted and continues until all revenue is collected.

Bad information at intake is the death knell of a claim. Wrong policy numbers, out of date coverage, prior authorization failures – these are all preventable but only if someone verifies that the patient is eligible for services before the appointment not after the claim is denied.

Coding is the area where the clinical work is converted into a language that the payers can understand. A wrong CPT code or wrong ICD-10 code can take weeks to be paid or constitute an automatic denial. This is where the smart code writers with knowledge of the quirks of individual payers make a difference.

A clean claim goes quickly. When it's messy, it's in a line and gets kicked out and goes back through the cycle. A review of claims prior to submission (not after rejection) is one of the easiest ways to accelerate cash flow.

All payments must be properly recorded and itemized against the billings. Either skip this step, or do it shoddily, and the visibility is lost – you don't know what is paid and what is unpaid.

Denials are inevitable. The difference between a healthy revenue cycle and a struggling one is the speed at which the denials are discovered, corrected, and resubmitted (rather than simply dismissed).

Money that's uncollected, but earned, is money that sits in accounts receivable for more than 60 or 90 days. Continuous monitoring of aged claims is frequently the most significant means of enhancing cash flow.

These components, working together, rather than separately, have a noticeable impact on the financial operations of a practice.

The answer is that there are many practices out-sourcing this function.

Earning all these things internally requires more than good intentions, it requires dedicated staff, regular training on payer rule changes and software a majority of small and mid-sized practices do not have the budget to keep up properly.

This is why many providers are relying on third-party revenue cycle management services to generate revenue instead of hiring a comparable staff. It's not a matter of cutting corners, it's a matter of utilizing specialized expertise without having to hire, train and retain an in-house department.

Hired Billing Support's RCM solutions are built around this need, providing experts that will work within your current EHR (Athenahealth, eClinicalWorks, Kareo, AdvancedMD and others) system instead of making your practice adapt to a new system. That is more than just an important distinction. When billing takes place during your workflow, rather than in parallel, you'll save time on data entry and reduce the likelihood of things getting lost.

One thing to say the word "efficient. Though it's another to put that into practice.

Those who have experience in using a dedicated RCM partner have seen their average AR time reduced from 47 days to 22 days, or nearly half. Clean claims are at about 98% on the first submission which means that a lot fewer claims come back for corrections. In a single primary care practice that comprised four doctors, claim denials plummeted by 47%, and over $112,000 in aging receivables was recovered within 90 days of the transition to full revenue cycle management?

These are not theoretical efficiencies, it's money that was already made but never cashed out till somebody really went after it.

One of the major concerns of outsourcing is the cost. The comparison isn't outsourcing versus free, though: It's outsourcing versus the actual cost of an in-house billing department, including salaries, benefits, software licenses, continued training and turnover when a trained biller leaves the organization for a better job elsewhere.

Unlike a flat fee no matter how much the company performs, most outsourced RCM models, including Hired Billing Support, operate on a percentage of what’s collected — normally 3–7%. That's the way the incentives get aligned: When your practice gets paid, your billing team gets paid, and not when claims are submitted.

This method can be as much as 50-60% cheaper than having an in-house team, and provides the same level of follow-up and reporting.

Poor denial handling is one cost factor that's a silent killer for practices. Denied claims are not a dead end, but a sign that something in the process is not working properly; perhaps a missing piece of documentation, a coding mistake or a missing authorization.

Those that deny because they put it first rather than last, usually see significant improvements in collections in a matter of months. That means that someone's got to be monitoring denial patterns over time – not simply submitting the same claim and hoping for a different result.

A few questions to ask before signing a provider with a revenue cycle management service to ensure that they can be trusted are:

Are they compatible with your current EHR or do you need to switch EHRs?

Are they based on collection or a flat fee for no matter how many collections are made?

Do they have actual performance figures (AR days, clean claim rates, denial trends, etc.) or just sweeping claims?

Do they have proper security measures to protect patient information that are HIPAA compliant?

Is there a long term contract in place, or can your practice break off if the relationship is not successful?

Hired Billing Support directly addresses each of these: EHR-agnostic integration, HIPAA compliant infrastructure and encrypted data handling, clear monthly reporting, and no long term lock-in contracts. The pricing structure is based on collections and not on paperwork.

Revenue cycle management is not meant to replace your front of office staff or introduce more bureaucracy. It’s about ensuring the financing aspects of your practice play out as well as the clinical aspects already do.

When verification, coding, claims, payment posting and denial follow-up are all connected, they appear where they are needed most – in a shorter AR days, fewer denied claims, and a much clearer view of your practice's financial standing.

If you find your team is busy on chasing claims rather than concentrating on patients, it may be worth outsourcing that to specialists who spend their time on claims. Sometimes, the best practice gain is not to attract more patients — it's to get paid what they deserve for the ones you already have.