Changes in payer models have placed providers at the front lines of efforts to control healthcare costs. Payer initiatives, combined with a sharp increase in patient selfpay, along with the transitions to ICD-10, pose significant challenges to provider Revenue Cycle Management (RCM) through the risk of decreasing reimbursement rates, increasing denials and escalating consumer collections.
The answer to these challenges is to keep pace with compliance, shifting payer models and the move toward self-pay by sharpening RCM best practices. The key here lies in viewing all practice functions as having a critical RCM role and leveraging the valuable data captured in EMR and Practice Management systems.
In addition to the core purpose of delivering quality care, almost everyone working in medical practices performs a function relative to their organization’s financial well-being. RCM isn’t strictly back-office billing; the transactional nature of care delivery begins with the patient appointment and continues through all subsequent patient interactions. As a result, every functional area within a practice represents an opportunity to employ the best methods to improve Revenue Cycle Management.
The first opportunity to protect the revenue cycle is at the front office, and it is essential to address it because patients are increasingly responsible for their own healthcare costs. That increase is happening because the purchasers of healthcare coverage – both companies that provide employee health insurance plans and consumers with individual plans – increasingly turn to high-deductible options as the most effective means to control monthly insurance costs...
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