Will Back Office Service providers reduce Healthcare Revenue Loss?

RCM Companies with Back Office Services inhibits Revenue Loss

Revenue flow has been limited in this pandemic situation due to constant lock-down. Back Office Services can battle your barriers and halt revenue loss. Believe it or not!

Back Office Services in RCM companies is a profitable revenue stream where the healthcare professionals can go on ease with patient responsibilities. It has a unique method for dealing the payments to make sure there’s a smooth and seamless flow of revenue.

How do RCM companies‘ Back Office Services Perform:

• Healthcare providers transfer the patient’s clinical documentation and coding responsibilities for the revenue cycle management company to continue the back end services.
• As a part of their job,Back Office Services staff engage in claim management, medical billing and patient collections.
• RCM companies hold the demographic details of the patient and prepares to submit the claims based on the accurate information provided.
• Two critical aspects of Back Office Services in RCM companies are :

1. Claims Management
2. Medical billing and Patient Collections.

1. Claims Management:

• After every patient visit, it’s Revenue Cycle Management team’s duty to perform charge capture responsibilities. It’s a process of translating services and healthcare provider’s time into billing charges.
• Charge entry team gets into scene to link clinical codes to a price. But when inadequate clinical documentation is submitted, it can result in revenue loss because of inaccurate charge capture.
• So, Organizations or Revenue Cycle Management companies often concentrate to flag charge capture challenges by adding accurate charge entry. However, a systematic way of charge capture date will improve Back Office Services’ process.
• In order to trend the data, conversation with the clinical teams to understand their workflow on what potential opportunities we had within the solutions is extremely helpful.
• With trending capabilities, net revenue improvements can be witnessed in a shorter period of time by the companies.
• It is noticed that Back Office Services’ team in a RCM company can create and submit the claims with the billable fees. ICD-10 and HCPCS codes are sent to patient data and health coverage information, staff ensures all the necessary details are entered in the claim before submitting to the insurance companies.
• Claims management is possible for a wide range of Insurance companies. Different payer requirements can fulfill and make a claim submission challenging.
• Clean claims are ideal and often the medical billing team scrubs the submission to prevent the claim from being denied.
• Back Office Services also should verify the clinical documentation and charge entry to ensure the accuracy of patient and health insurance information to check if appropriate codes and modifiers are entered.
• Inescapably, a certain group of claims will return to the billing team as denials. Their work is to review the denials and attempt to find the reason for denials and rework on it for a post payment.
• It states that about 90% of claim denials can be prevented and be corrected for a payment. Over one-half of the claim denials are never submitted to the Insurance companies.
• It’s evident that medical billing teams in most of RCM companies are not prioritizing the claim denials but focusing on the new claims.
• A standard procedure is followed by RCM companies with back Office services to work on the denied claims alone every day. If a claim is rejected once, doesn’t mean it can be rejected or denied forever.
• Reworking on it with necessary requirements can capture the reimbursement with attention and make an attempt to release the payments.
• Claims those are qualified for a reimbursement must be ensured and checked if the insurance companies has correctly paid the organization or RCM companies according to their contract.
• Assessing payer performance and accuracy helps RCM companies for better reimbursement rates and improve medical billing compliance.

2. Medical Billing and Patient Collections:

• If once the claims are examined, any remaining claims in the patient account must be sent to the collections.
• Medical billing team will take on their shoulders to create and send bills to patients to collect the full financial payments.
• Back Office Services collections can be more challenging than expected for providers. So, they not only expect collections between 50 and 70 percent of patient’s balance but also takes at least a month to receive payments from patients.
• Whereas RCM companies confronts all the challenges to deliver 100% payments with the help of Back Office Services they render.
• They can also improve patient collections by electronic payment options through patient portals.
• Only thing that’s repeatedly heard in patients without ton of emphasis from physician will often choose to pay online.
• If the payments are delayed, it would be hard for the healthcare providers to deal with the loss of revenue.
• In order to halt the revenue loss, Back Office Services Company allows the AR follow-up team to have a regular follow up with the electronic claims until the payments are posted.
• It’s easier to go online and look through the details of the payment, visit and pay by credit card right away rather than submitting a check in the mail.
• As Back Office Services team collects the payments they complete posting payments and closing the accounts.
• Reimbursement and Patient payments touch a various departments. So, revenue cycle management team should partner and constantly communicate to ensure smooth revenue flow.

Artificial intelligence handles Back Office Services in RCM Companies:

• Healthcare tends to employ more number of staff as the work can be highly repetitive and manual.
• But many executives and Back Office Services professionals believed and realized that process such as Patient eligibility, Pre-Authorization and Claims Processing can be automated.
• This could make staff to engage various patient interactions. There are hospitals which has patient billing cycle less than 30 days. Longer delay in billing will affect organization with no doubt.
• AI powered chat bots and virtual assistants can be programmed to answer critical and common questions or respond to request raised.
• Human employees will have time to engage to the customers for more complex issues with the help of AI.
• Some healthcare plans are automatic and easy to answer immediately as soon as a question is shot by the customer. So no waste of time.

Benefits of Back Office Services in RCM Company:

1. It saves upto 50% of operating cost per person.
2. Highly equipped and access to 500+ skilled and trained staff.
3. Flexibility of scaling up and down accordingly.
4. 90% of claims paid on first submission.
5. Turnaround time is lesser than 20 days on an average.
6. Certified compliant process.
7. Customer support services that works globally 24/7.
8. Technically qualified and highly developed software technology.
9. Strict security policies and practices.

Back Office Services in a RCM company therefore prepares for a smooth revenue flow and exceeds its limits to push to its level of increasing the growth of payments and revenue for the healthcare professionals. It can be challenging sometimes but the revenue payments are guaranteed without any loss.

Revenue Predictions for 2021:

A recent study on revenue predictions for 2021 commissioned by American Hospital Association and conducted by Kaufman Hall revealed some shocking numbers. Here are some top findings:

• Overall, the healthcare organizations can incur a loss of USD 53 Billion to 122 Billion in the year 2021 due to the effect of the Covid-19 situation.
• The out-patient losses can mount to USD 27 Billion to 64 Billion whereas the inpatient cases can face a loss of USD 17 Billion to 41 Billion.
• The emergency departments are looking at a loss of USD 9 Billion to 17 Billion in 2021.
• The ranges are with respect to different levels of vaccine progress and patient volume recovery.
• Drawing a conclusion, Kaufman Hall said that the losses are still here to continue for the hospitals.

2022 Update on Healthcare Revenue Cycle

• Healthcare revenue cycle management has been suffering from losses since the beginning of the pandemic in the early days of 2020. However, to cope up with the various changes in the patient needs and their service patterns, the federal Government has come up with several regulations that went into effect from 1 January, 2022.
• Several healthcare organizations have welcomed the varied uses of artificial intelligence and machine learning backed tools to reverse the losses generated due to manual errors in clerical workflow.
• According to various surveys, close to 70% of the healthcare organizations switched to automation in revenue cycle management in 2021. Moreover, more than 90% of the healthcare organizations wanted automation tools particularly designed for RCM services like AR management, patient demographic entry and cash posting.
• Among those who did not use automation in 2021, said that they would not be switching to any automation by the end of 2021. However, there is a significant portion of the organizations who wish to change to automation tools in the upcoming years.
• Staff shortage has been another issue that the different medical facilities have been struggling with in the past one year. Automation tools have been extremely beneficial in coping up with these issues.
• Healthcare billing companies were able to maintain a stable revenue flow with their specific services like payment posting, denial management, old AR, returned mail processing, and credit balance management.

You can reverse this loss with the help of professional medical billing services from leading companies. Get in touch with them to get a tailor-made plan for you.

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