The practice is doing well. Patient visits are way up. The timing is right to expand. It’s an enviable position to be in and taking on additional providers can mean added flexibility to expand hours, increase revenue, and grow with your patient base. It can also spell problems if onboarding new doctors and advanced practice providers (APP’s) isn’t done in a comprehensive way to include education and training on the healthcare billing lifecycle and Revenue Cycle Management (RCM).
Most medical schools and APP advanced study programs include little to no business education and, if it is available, it’s usually viewing medicine and healthcare at the macro level. RCM is rarely discussed and providers graduate from school and enter the healthcare workforce without a foundational understanding of how the revenue generation and reimbursement process works. Whether fresh out of school or from an existing practice, there is a good chance that your new provider will benefit from practice-specific education and guidance.
How to Support the Clinicians’ Understanding of Their Role in RCM
The business of medicine is complex. Contracting and reimbursement issues can seem overwhelming, but it is critical to ensure doctors and APP understand their role in RCM. These five suggestions will help build a better understanding and hopefully communicate their critical role in a successful RCM program.
- Educate Providers on the Payment Lifecycle–Start at the beginning to help new providers understand the RCM process whether you have an in-house business office or engage a third-party RCM partner:
- Insurance Verification – Whether automated or manual, explain what information is gathered, how co-insurance, deductibles, and out-of-pocket maximums are calculated, and how the verification process affects your reimbursement.
- Pre-collections – With up to 30% of healthcare costs now residing squarely with patients, the pre-collections process is more important than ever.
- Prior Authorization (PA) – Primary care and specialty providers need to understand the PA process and the time constraints involved that impact patient care.
- ICD-10-CM, CPT, and HCPCS Coding, Billing, and Claims Submissions – Once a superbill has been filled out, new providers would benefit from understanding the journey it takes to be paid from their documentation process, through coding and billing to payment or claims denial. In this case, an ounce of education may be worth more than a pound of saved effort and rework down the line.
- Insurance Contracts and Write-Offs – It’s critical to educate incoming providers on the details of insurance contracts and the associated contractual adjustments to revenue that are the cost of doing business. Rarely do new associates understand that the work they do may have 25 to 30 to even 40 percent written right off the top as part of the group’s contracts. While disheartening for the new provider, it’s imperative they understand how to maximize their time and treatment options.
- Denials and Rejected Claims – The impact of denials is pronounced and enlisting new providers in their reduction will be significant to the bottom line.
- Ensure Providers Remain Current on Coding Requirements–New providers will need to be educated on the requirements for CPT coding and how it relates to the ICD-10 coding process that takes place as the claim is prepared for submission to insurance. In 2020, there were 394 changes to the CPT and HCPCS code sets and all providers have a financial interest in staying current.
- Set Expectations on Proper Documentation–Timely documentation has several benefits and timing expectations should be set from the beginning. The RCM process relies on providers swiftly preparing their superbills/coding sheets with each patient’s daily charges. They must also document or transcribe medical notes into the EMR, including procedure specifics necessary for precise coding, i.e., lateral vs. bilateral, specific vs. non-specific, etc.
- Train and Guide Providers about Patient Financial Issues–It’s not uncommon for providers to be approached by patients about financial issues. A patient may ask a provider for special consideration of a debt or have a complaint about the cost of a procedure. Training and guiding new providers on how to respond to these inquiries will help create a united team dialogue and circumvent any misunderstandings that might happen. It’s important that all providers have a specific place to refer patients for answers and suggestions.
- Allow Providers to Review Financial Statements–One of the most effective ways to enlist new providers in the health of the practice is to include them in a monthly review of financial statements and account receivable information. Since there may be proprietary detail that is partner-specific, a general summary is adequate to keep people engaged and feeling part of the team.
Through demonstrated leadership and accountability, you can set the tone for every provider to have a stake in the success of the practice. Increased provider satisfaction and engagement results when information is shared and achieving organizational alignment will help significantly in your retention efforts.
Contact us today to request an RCM Health Check and ensure your practice is ready to expand.