Before the development of claims processing software and specialized digital platforms, the entire revenue cycle had to be managed manually.
Filling out paper claims forms, verifying a patient’s insurance coverage (usually over the phone) and then checking the mail for payments (or denial notices), making follow-up phone calls to payers tracking down payments, finally getting paid and posting the (hopefully accurate) payment, or dealing with a denial – the RCM process was often slow, unwieldy and full of errors.
Information technology has greatly increased the number of claims that can be quickly and accurately submitted to multiple payers, tracking claims’ progress, and managing any denials. By improving the initial accuracy of the claims process, from verification of coverage to the final payment posting, the reduction of expensive denials and errors are sharply reduced. Digital portals as well as telehealth options help patients stay in touch with providers, even in remote areas. Documentation that used to take days to retrieve and submit now takes just seconds with the click of a mouse.
Factors That Can Affect RCM
A number of factors come into play with managing revenue cycles, besides technological shortcomings. Human error is probably one of the biggest causes of billing and posting mistakes, as shown below:
- Increased technological emphasis is on improved payer verification, increased accuracy in billing “clean” claims, better follow-up, and the ability to deal effectively with potential denials
- Increased chances of human error when claims processed manually or with outdated claims software and related technology
- A growing intertwinement of payer policies, each with their own billing and reimbursement criteria, as well as government regulations present challenges for practices and others facing a money crunch¸ with training and updating challenges
Interoperability is a key to an organization’s successful RCM, as provided by improved technological solutions to the older manual processes, reducing labor costs to produce “clean claim’ submissions, follow-up, and if necessary, resubmit or appeal denials. Accessing these newer, more efficient technologies is often difficult for organizations due to the need for coordinating interface between clearinghouse integrations, billing software, EHRs and add-ons.
Many healthcare organizations are challenged by a mix of cloud APIs as well as the differing interfacing demands, in the quest to achieve actual interoperability within their own revenue cycle systems.
It becomes clear that for many healthcare organizations, especially smaller or new practices getting underway, attempting to come up with a one-size-fits-all solution can be not only prohibitively expensive but simply unworkable for many organizations. That is where Bikham comes to the rescue by offering group or private practices as well as other healthcare organizations an array of personalized services, technologies and tools for staying on top of one of your most important goals: revenue cycle management.
Collecting Patient Payments
Patient statements should be created in an easily-understood format to help patients see the charges, any adjustments or discounts, what payers have paid, as well as their responsibility. With that in mind, Bikham’s goal is to reduce inbound call volumes from patient questions through improved clarity of statements.
When it comes to getting the money your lab or practice is due from patients, Bikham isn’t a third-party collector, and doesn’t resort to those types of tactics. They do offer professional, polite protocols when contacting patients for payments. Patients are offered easy, convenient online portals through which to pay online, including paper checks and merchant account card processing. Patients are able to reach out by phone, text, or email, with all patient and financial information safely encrypted as per HIPAA requirements.
Fragmented Administrative Processes Issues
What happens to RCM when the processes are fragmented or disrupted at the administrative level? One of the results are claims backlogs from aged AR or “stuck” AR, which can cost you thousands annually in lost or severely delayed revenue. These can be caused by rejections, denials or other missing information that was missed by short staffing problems, or a billing company failing to put in the time and effort. An overworked administration department dealing with many other issues may result in aged claims being put on the back burner.
Our solution: turn over those aged claims to Bikham: we’ll collect on the denials and rejections that have gone missing. We get paid only when you get paid.
Eligibility Issues
As one of the most critical parts of the revenue cycle, benefits and eligibility verification (BEV), Bikham thoroughly reviews your patients’ plans for coverage of any treatments or procedures planned. Our proprietary technologies and experienced staff have reduced clients’ eligibility-related denials by as much as 7- 10%!
Bikham examines your payers requesting pre-authorizations and related codes, working with your own providers and staff to ensure pre-authorization is obtained in a timely manner before the hospitalization or treatment. If retro-authorization is applicable, Bikham ensures that authorization is applied for either up front before need, or within the retro-approved time frame.
Obstacles to Managing the Digital Workflow
When your organization’s workflow is lacking access to fully digital revenue management solutions, your administrative staff can find themselves overworked and overwhelmed. Just performing regular follow-up on dozens of different claims on a daily basis using outdated software can cause tracking and posting headaches as well as the possibility of having to rebill a payer if a claim has been lost or denied.
Because one-size doesn’t fit everyone, Bikham offers customizable revenue cycle management modules designed specifically for your organization, whether a small practice, laboratory, nursing facility, rehabilitation facility or hospital.
Best-practices suggestions:
For success at the front-end, which of course determines the ultimate back-end success, an organization must start with the selection and the purchase of comprehensive, seamless solutions providing the uninterrupted flow of data between various workflows.With their emphasis on IT infrastructure support, secure storage of patient information and HIPAA-compliant billing solutions, Bikham is perfectly positioned to help clients take their RCM to a higher level of productivity and profits. To learn more about their innovative services, email Bikham or call 1-800-940-4943 to take your RCM to its full potential.
