AquinaJanuary 31, 2019

Staffing The Back-End Of Revenue Cycle Management

Staffing The Back-End Of Revenue Cycle Management

The healthcare revenue cycle consists of every administrative and clinical function that is associated with the collection of patient revenue. RCM, or revenue cycle management, is the set of processes that make all of the different areas work together. In our previous blog, we discussed the different functions of front-end RCM. This week, we’ll take a look at the importance of proper staffing of back-end RCM positions.

While the front end staff of a traditional RCM model primarily handles patient-facing aspects of care, such as patient scheduling, clinical documentation, and medical coding, back-end RCM responsibilities are more focused on billing, claims, and collections.

Claims management.

There are several different areas of importance that fall under claims management. One of these is charge capture. Charge capture is an integral process, as it’s what turns clinicians’ time into a billable set of service charges. Smaller practices may have a single responsible party for this process — a chargemaster — while larger healthcare organizations may have multiple charge capture specialists and a chargemaster who oversees the consistent application of pricing to clinical medical codes.

Another claims management responsibility is handling the submission of insurance claims to payers. One of the most frustrating and common bottlenecks in the RCM process is the denial of claims. In fact, a recent study stated that the healthcare industry sees anywhere from $11 billion to $54 billion in challenged revenue each year. However, a solid RCM system and a dedication to staff training can prevent many of these claims denials and challenges. Focusing on submitting clean claims, understanding payer fee schedules in advance, and clearly documenting medical necessity are all ways to keep denials to a minimum.

Medical billing and patient collections.

Once claims are finalized by the payer (insurance company), medical billing staff steps in to generate bills and invoices for treatment. While most practices still send physical bills, many send electronic versions as well, and/or offer an online payment portal. In fact, many patients prefer to pay online now whenever possible, so making an e-payment option available is one relatively simple way to simplify billing and expedite collections, while minimizing the amount of time staff need to spend on the phone following up or taking payments via credit card.

When patient bills are not paid in full by a given due date, collections representatives take up where billing staff left off. The first order of business is always to try and work with patients to create a plan to collect their full financial responsibility. Empowering these staff members to offer flexible payment solutions for those who need them is one way to keep accounts from being sent to collections, which ultimately may have a worse chance of being paid. However, if a plan cannot be put into place, any balance remaining should be sent out to a pre-contracted collections agency for resolution. This is the final step in healthcare RCM and is what closes the healthcare revenue loop.

How Via can help.

While front- and back-end RCM functions are quite different, they both ultimately contribute to the smooth flow of revenue that fosters a healthy practice bottom line. Unfortunately, even the best and most well-trained RCM staff can only do so much to expedite claims through the vast and complex insurance system. This is why many practitioners have chosen to integrate Aquina’s Via solution into their RCM. Via is a tool that expedites insurance claim reimbursements and is invisible to the patient so clinicians are paid faster. With integration already in place with leading EHR providers such as athenahealth and Kareo, getting started is easy. Contact Aquina Health today and find out how.