Outsourcing RCM: How a RCM Service is the Best Solution for Claim Denials
Revenue cycle management (RCM) is an important process for every medical organization in the country. It can literally be the difference in a practice achieving financial success or closing its doors.
There are a few different ways to approach RCM, either with an in-house billing staff or outsourcing RCM altogether through a RCM vendor.
Typically, in-house billing is the choice for practices initially, but it's certainly not always the best. But how can you tell if it's time for a change to outsourcing RCM services? There are several indicators, but consistent issues with claim denials - both in receiving and failing to fix - is a major one.RELATED: The Top 5 Most Common Medical Billing Denials
Last week, the InSync Blog tackled the five most common medical billing denials. When reviewing them, they all seem like small mistakes, but triggering denials, especially if it's a recurring issue, can mean significant financial hardship for a practice. Even if denials are eventually handled and solved, cash flow will still be delayed. At worst, the denial is never fixed and the practice misses out on the revenue altogether.
According to the Medical Group Management Association (MGMA), practices receiving denials on more than four percent of their claims are in financial trouble.
If claim denials are a consistent issue, it may be due to either a lack of billing experience among the in-house staff members or a representation of a breakdown in the practice's billing process. Either way, it's an issue that needs to be fixed sooner than later.
With the right RCM vendor, outsourcing your practice's RCM services is a practical way to combat rising denials. Ideally, the RCM software will leverage its tools as well as the experience of its billing experts to submit claims more accurately.
As a result, the stress of claim denials disappears for the practice. Most importantly, the practice is able to receive its money on time.
Additionally, the right RCM vendor will act as an advocate on the practice's behalf regarding claim denials. A proactive approach to claim denials from the vendor will help the vendor better anticipate claim denials by studying trends and avoiding them altogether. The final result is a more financially stable practice.