Determine what is collectible and what is owed and increase your specialty practices RCM performance

Gone are the days when health plans were easy to develop.

Now, health plans are becoming complicated. Hence, revenue cycle management is transforming into a big challenge for specialty practices. Why? It is because of elements like copayment values, co-insurance roles, and covered services now being in the mix.

Two health plans that affect Revenue Cycle Management the Most:

High deductible plans and plans accompanied by co-insurance.

What are deductibles, co-insurance, and collectibles?

The term refers to the amount that patients pay from their own resources before insurance is applicable. Co-insurance is the amount that patients end up paying after insurance.

When you combine the two, you get collectibles that need to be collected from patients rather than insurance companies. This signifies a significant chunk of revenue for specialist practices.

So, what’s the challenge?

The challenge that specialty practices are facing now is knowing what is deemed as being collectible from patients. More and more health plans are springing up. Each has varying technicalities. Thus, it is difficult to know the accurate amount of reimbursement to collect from patients.

Even the patients don’t find the process to be a piece of cake. Most of them are unable to understand the complicated plans and their financial obligations. So, when you don’t know what amount to collect from patients and patients don’t know how much they owe you, the revenue cycle is bound to get hampered.

What can specialty practices do?

Making use of electronic verification is the first thing specialty practices should do. Getting the information regarding the financial responsibility of patients is not hard for practices. All they need to do is incorporate a practice management system. The system can then be used to educate each patient about their financial responsibility as well.

This helps in making sure that collections are made timely and efficiently. They shouldn’t have the administrative staff or the physician perform the role of informing patients. Instead, practices can make use of financial counselors. These counselors can conduct meetings with patients. This can occur before their treatment. The role of the meeting is to inform them of their financial responsibilities. Here, the practice can also assess whether the patient can pay the expenses or not.  Necessary payment arrangements can then be made.

Improving first-time payment rates

Another aspect of the revenue management cycle that needs to improve is first-time payment rates. This can also be streamlined using electronic reviewing and pre-authorization methods.

Additionally, technology can also be used for verifying insurance plans. At the same time, auto-charge capture can be used as well. This will help in knowing about reimbursable services. These services are those which are part of the medical records of patients.

Conclusion

To improve revenue cycle management performance be sure to know about your collectibles. This is the first step towards effectively collecting them and for realizing your revenue.

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