Use of Customizable Workflow Tools to Improve a Practice’s RCM

How can I improve my RCM

It is known that there are numerous RCM and medical billing companies in the country, utilizing quality individuals, that perform proficient medical billing, collections and patient financial services for their clients. However, none of these organizations have an innovation empowered revenue cycle services and workflow tools. BillingParadise is a pioneer in real time reimbursement automation and revenue cycle workflow innovation solutions and medical billing related tools that enable clinical businesses, hospitals and health systems to gather the most cash in the briefest time conceivable.

RCM workflow tools and technologies help smooth out what’s more automated RCM work process while upgrading the medical billing cycle, giving definite straightforwardness and perceivability into the revenue cycle management process. BillingParadise’s workflow solutions protected programming, combined with our experienced revenue cycle staff, are at the core of our services which isolates us from any other RCM organizations.

RCM processes set up in different practices are always in bits and pieces. They always have a gap to fill or avoid that gap and leave it unattended. This is where the workflow tools come into play.

What is a RCM workflow tool?

A RCM workflow tool is used to categorize the parts of RCM operations staff and link them into a transparent communicable platform which allows these RCM staff to achieve good production and quality. Usually a hospital or health systems RCM workflow consists of at least 10-15 staff working together,EHRs only provide partial connection between these staff. Let us see how using workflow tools for each of these processes benefits the entire RCM:

Patient registration:

Patient registration is the first process of any successful practice. The pre registration process is to collect necessary information from the patient before rendering the procedure or service. Using workflow tools like “Team Billing Bridge” will allow communication with the billing staff and front office staff responsible for collecting patient information. If any questions or concerns about a particular patient information raised by eligibility and benefits verification staff is recorded as a ticket so that the front office staff can acknowledge and do the necessary next action.

Eligibility and benefits verification:

Eligibility and benefits verified should be provided to the doctor as well as the front office. Using the workflow tool the doctor can receive the complete benefits information for the services going to be provided for the patient, because few patients have benefit limitations which can be explained by the provided at the time for service educating the patient about the benefits for the doctor’s particular specialty. This eliminates confusion in pre claim transmission processes like charge entry and coding

Eligibility verification

Charge entry and coding:

Most errors occur in the pre-claim transmission processes like charge entry and coding. The reason why is because of the lack of communication between the records staff who create charts for the services rendered. Sometimes the codes captured may be incorrect to solve incorrect information recorded in charts, creating a section using a workflow tool to revert the errored charts explaining the corrections by the coding team will allow the records staff to keep the charts clean which can come in handy when insurance companies request these charts to audit by their medical examiners. Incorrect charts may result in bad reputation of the practice with the insurance companies and are subjected to frequent audits creating hassle in the RCM process.

Eligibility verification (1)

Payment reconciliation and posting:

Offsets, recoupment and over/under payment is the direct result of not consolidating payment information from insurance companies properly. Using a workflow tool which can have recorded information of all the payments and recoupment on a daily basis will allow practices to stay one step ahead of the insurance companies. Payment posting staff can be included in this workflow tool to have this data readily available to CFOs, CEOs and other top level management people to be notified and come up with better resolutions to avoid this issue.

Accounts Receivable and denial management:

Finally the end of the RCM cycle comes to a point where the unpaid claims need to be resolved. Since most of these claims are errors done by the above-mentioned RCM process staff, AR and denial management staff can create their own link to their colleagues in other departments to provide the right resolution for each and every mistake. Say for example a coding mistake or denial has come across and the denial management staff need additional assistance, including or assigning these claims to coding staff in the workflow tool and creating a priority level which will enable them to provide an answer as soon as possible without timely filing exertion is the best way to use a workflow tool. 

Not only the staff who are actively working on the RCM process can use these Workflow tools and it’s features, billing managers and other leadership staff who oversee the RCM operation are kept informed about the quality of work done by each of these RCM staff. If a charge entry staff has done any mistake and the claim is already submitted and was denied, the denial management staff can place this error in the charge entry staffs bucket so that the management can analyze their productivity and quality, this allows them to train these staff and keep them educated on the changes or guidelines issued by CMS and all the other insurance companies effectively. 

Eligibility verification (3)BillingParadise’s “Team Billing Bridge” App is an intertwined comprehensive workflow tool which benefits your clinic, hospital and health system function better during these pandemic times and reduces confusion and blame games.