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Complexity of RCM Leads Practices to Outsource

January 25, 2022

Your facility’s financial success is attributed to multiple factors, with revenue cycle management at the top of the list. From collecting payments at the front desk to handling your AR, managing the complexities of the revenue cycle should not be stressful or taxing on your staffing. Coronis Health provides the specialized solutions for outsourcing your billing and revenue cycle management needs so you can focus on the most important aspect of your business – the patients.

What is RCM?

Revenue cycle management, or RCM, is a full-circle process that culminates with your facility earning revenue from the services delivered to patients. The cycle starts with the simple task of registering a patient and verifying their eligibility and insurance, and ends with the final collection from the patient or insurance payer. The process may seem lengthy, as it involves multiple players, including the patient, facility, billers and coders, and the health insurance companies that reimburse a hospital or healthcare facility. Ultimately, the management of this process falls on the healthcare facility, so a full understanding of the cycle is critical for the success of an organization.

Why Is It So Complex?

Revenue cycle management is not as simple as a retail store collecting money for a sale, which happens instantaneously. Patients receive services before a billing department submits a claim, and if a claim is denied or part of the claim is not covered, the reimbursement process is delayed. Additionally, the changes with ICD-10 create challenges that demand accurate documentation and coding, so if a healthcare facility does not engage in effective billing practices, the rate of denials increase, and accounts receivable (or A/R, the amount of money an insurance company owes a healthcare facility) can soar to an unmanageable level. Increased denials make it difficult to collect earned reimbursement from insurance companies.

Coronis Health RCM stock image of man looking at charts for a page about mental health medical billing services

RCM Challenges

Revenue cycle management presents challenges that require a healthcare facility to focus on multiple factors to ensure the process is successful. The following challenges demand a savvy team of experienced professionals who know and understand the full circle of revenue cycle management:

  • Prior authorizations are necessary for healthcare facilities to ensure that a patient receives care that an insurance company approves prior to the date of service. Providing care or performing a procedure without prior authorization could lead to claim denial, and ultimately place the responsibility of payment with the patient.
  • Revenue integrity involves capturing accurate charges, which determine the amount of reimbursement a facility receives. Facilities with specialties may face more challenges as they focus on value-based care, bundle their charges, and perform procedures.
  • Accurate coding is essential to ensure that patient encounters, procedures, laboratory and imaging services, and surgery claims capture codes correctly to prevent loss of reimbursement. Incorrect coding can result in a loss of revenue for a facility.
  • Management of A/R is critical for a healthcare facility, as it determines how soon reimbursement is received after submitting a claim. Keeping A/R under 30 days needs a team of dedicated individuals who understand and implement effective strategies to lower denial rates and increase collection rates.
  • Credentialing and proper enrollment with an insurance payer is required for reimbursement. Physicians or facilities who are not enrolled or not “in-network” with a plan could face negative revenue outcomes, which also affects patients who receive services.

Coronis Health moves past these challenges to create success and alleviate the stress of billing, coding, and the revenue cycle process.

Benefits of Robust RCM

Coronis Health RCM Workers at a table for a meeting

Outsourcing revenue cycle management is a choice that many healthcare facilities are making to ensure they have certified professionals who engage in regulated, proven methods of obtaining prior authorizations, accurate charge capturing and coding, claim submission, denial and A/R management, and collection. A robust revenue cycle management ensures that all pieces of the process are touched with every patient encounter, with zero money left on the table. The effective utilization of a revenue cycle team creates the centralization a healthcare facility needs to meet the challenges the industry presents with enormous amounts of data, changes, and regulations. It also aims to keep a facility operating with its doors wide open to care for patients.

Coronis Offers RCM Services

Don’t think that outsourcing means you lost control – in fact, you are creating more control for your facility as you are creating opportunities to create process improvement in other departments that may have suffered productivity or revenue losses. Let Coronis Health do the heavy lifting with revenue cycle management. Coronis offers services that optimize your facility’s revenue while streamlining your processes:

Choose Coronis Health for Your Outsourcing Needs

Choose the best – choose Coronis Health for your outsourcing needs. We offer superior medical billing and technology innovation, integrating our services with your needs. We combine 100+ years of experience to tailor solutions and offer more than just medical billing. We go beyond your expectations with the latest technology, forward-thinking, and robust business intelligence. We grow with your processes and provide you with the services that maximize your revenue cycle management. We understand your needs, build trust, and gain a firm perspective of your facility’s goals, mission, and vision. Trust us to create a revenue cycle management team focused on your success.

Interested to learn more? Request your free financial checkup and find out why Coronis Health is the optimal choice for your healthcare facility. 

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