For many physician groups, medical clinics and hospitals, staffing shortages in the business office have contributed to a variety of cash flow obstacles. A/R backlog continues to affect cash management as the volume of unpaid claims is a constant concern. In a recent article published by Becker’s Hospital CFO Report, one Vice President of Revenue Cycle at a health system with 25 locations was quoted as saying that “high vacancies and leaves of absence are the top issue for many RCM departments.” Another commented that “My key focus right now is staff stabilization” (see Becker’s Hospital Review, October 5, 2022).
Adding to the complexities of maintaining revenue, many health systems are also in the process of updating or changing their outdated EMR/PM systems and legacy billing applications. Mergers and acquisitions also bring into play a significant amount of training and manual work to reconcile, distribute and report on all payments being posted (or re-worked) from multiple locations, business units, divisions and HIM sources.
Outsourcing RCM Functions
In obtaining help with outsourced RCM services, options range from more targeted areas of need to outsourcing a large portion of the entire revenue cycle. Many vendors specialize in one specific area, such as patient access, billing, coding or the collection of unpaid claims. Whatever your priorities are for staff augmentation, or with eliminating a constant backlog, identifying the right vendor is critical to making the process as efficient and effective as possible. One of the first steps in planning is to identify those processes where a vendor (or multiple vendors) can deliver the most financial impact within a designated time frame.
How Can RCMS Augment Your Business Office?
Along with ReMedics LLC, our BPO sister company, RCMS can provide for a variety of payment processing, data validation and bank reconciliation services that can optimize financial performance, reduce posting backlogs and increase cash. We can also assist with the splitting of ERAs to help with payment posting to legacy systems while going through a systems migration.
With the use of Robotic Process Automation (RPA) and other data management technology, our BPO services can also include the processing of PLB adjustments, co-pays, deductibles, co-insurance, transfers, write-offs, take-backs, remark codes, denials and much more.
RCMS Data Validation
Our Data Validation services ensure that correct information is applied to the patient account by helping to scrub and cleanse all of the captured data prior to posting. Once the data is received, our proprietary ReSolve™ Revenue Cycle Managment Solutions automatically begin to apply client-defined rules that find potential cash application errors before posting. We route those exceptions back to the client through dynamic worklists, while sending the validated information to the host billing system for posting.
RCMS Reporting & Data Analytics
RCMS provides pre-defined detailed reports and scorecards with key performance indicators (KPI) and other relevant data needed for monitoring of all the work being performed — across all departments and divisions. Clients also have the option to incorporate Microsoft Power BI as a data source for drill-down analytics and statistical analysis.
Let us know some details about your business office and outsourcing requirements. RCMS can arrange for a Cost/Benefit ROI Analysis and develop a detailed project plan. Long-term strategies for implementing permanent change, including the use of workflow automation technology, should also be considered. Contact RCMS today to improve your cash flow and entire revenue cycle.
A version of this article can also be seen at ReMedicsHC.com.