Coping with Reform: Renewed focus on revenue cycle management Print
Written by Barry Walters   
Monday, 05 July 2010 16:05

Payment errors cost U.S. medical groups billions of dollars annually.  A $2,000,000 practice typically loses $100,000-140,000 a year on claims paid at less than the contract rate.  This problem can be broking down into 5 key points:

*         Billing and collections consumes 5% to 8% of practice revenue    

*         Heightened scrutiny by payors of all claims leading to an increase in the number of denied claims

*         Increase in the complexity of billing rules. 

*         The number of provider plans is increasing.

*         Change in federal and state legislation have increased the administrative burden on physician practices.

Practice management systems alone cannot correct this because they are not designed to identify or track contractual payment errors.  Solving this problem requires a practice-specific payor contract knowledge base which can value the services performed according to the complex terms of today's healthcare contracts.  The solution is a physician revenue cycle management that encompasses a unique integrated solution which includes web-based practice management software, claim submission, electronic eligibility verification, payment posting, claim follow-up, denial management, insurance rule creation, insurance contract definition, appointment reminder calls and more.  All designed together to increase a practices revenue and meet challenges of a vastly complex medical practice landscape.

With the impact of the historic legislation to overhaul our nation's health system many questions concerning its potential implications for the physician community are arising.  Most of these concerns are around Insurance billing and patient management.  Practices need to have the foresight to set up an all inclusive revenue cycle management system that will probe the key concern of billable dollars and give them the ability to get paid what they deserve from the insurance companies.  Acting on this with give doctors the ability to understand the health of their practice at anytime and allow them the time to focus on the practice of healthcare and not the business of healthcare

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Last Updated on Thursday, 23 December 2010 06:55