Revenue Cycle Management (RCM) is a necessary piece of the healthcare puzzle and it remains an integral part of the success of any healthcare business. When a clinic outsources the management of their revenue cycle, they entrust an outside company to handle coding, claim submission, collections, et al. Some practices choose outsourcing RCM due to cost-benefit analyses, spacing and time issues, or convenience. Other practices retain in-house management of the revenue cycle, traditionally when they have experienced, trained coders on staff and a time-tested process already in place.
All practices are not alike and have their own nuances to their revenue cycle. Look within, and evaluate your current situation to determine whether outsourcing is right for you. Whether or not you have considered partnering with a revenue cycle management firm or not, I am sure you have heard both success and horror stories. Below, I’ve debunked four common myths about revenue cycle outsourcing.
Physicians, hospitals and small medical practices are in a race to make sure they are in compliance with ICD-10 codes by October 1st, 2015. Switching their systems over has proven to be a bit more complex than anticipated. The reasons are that ICD-9 codes may have multiple mappings to much more specific ICD-10 codes or no mapping at all. The complexity of each system switch-over is different depending on the medical specialty, the codes normally used to provide services, and the type of office itself. Many providers are turning to special tools to help them make the switch, but in the end the usage of such tools will have to be customized to their particular practice.Read More
There are changes that will be coming in 2016 concerning the way Medicare will pay for medical services. On February 20, 2015, the Centers for Medicare and Medicaid Services (CMS) asked for public comment on its proposed changes to Medicare Advantage (MA) plans and Part D Prescription Drug Programs. The goal of the changes is to pay providers based on the quality of services they provide and not the quantity.Read More
While not the first time Medicare funding has undergone revision, (and likely not the last), the "Doc Fix" bill seeks to fix a long term problem with the system. This bipartisan effort is focused on establishing more realistic funding and for Medicare, affecting both patient care and physician reimbursement. This bill is considered a long-term fix, and not the more commonly used patch method to secure funding.Read More
In 2012, Centers for Medicare and Medicaid Services (CMS) published a rule that would require providers to report and refund any overpayments within 60 days from the date the overpayment was found. As an orthopedic provider, you have probably received some of these notices from Medicare. However, due to the amount of comments and extensive discussion around the issue, CMS has delayed its final ruling on the 60-Day Overpayment policy. Of particular concern has been the provision that this requirement could include audits going back as much as ten years. So what does this mean for your office? Read on.Read More