Medical practice's have to maintain a strong revenue management cycle (RCM) in order to sustain and provide relevant diagnosis and care to the patients. The revenue cycle is a core feature of nearly every health center that deals with administrative and clinical tasks pertaining to medical claims processing and submission to insurance companies and collecting payments.
A medical practice’s revenue cycle must be streamlined and effectively manage to ensure that the healthcare providers are timely reimbursed for their expert services and other overhead payments. Without proper financial management, healthcare centers cannot function and provide care to patients suffering from acute or chronic illnesses.
The Significance of Revenue Cycle in Healthcare
The success of maintaining a smooth RCM flow depends on accurate claim processing and accurate execution of ‘Medical Billing’ and ‘Medical Coding’ tasks. The RCM process starts when a patient makes an appointment and ends when payment is collected.
Medical coding is the process in which a healthcare provider or a designated coder identifies the diagnosis or treatment the patient has received and assigns the correct ICD- (International Classification of Diseases) codes.
On the other hand, medical billing is the process of submitting and following up on medical claims to the insurance provider so payments can be received for services given to a patient, which includes diagnosis, testing, treatments, and post-treatment consultation services.
In general, healthcare organizations have significant pressure to provide basic healthcare facilities and treat patients with chronic illness. As the baby boomer population is getting older, there is a considerable rise in people diagnosed with chronic ailments.
The Impact of Covid-19 on Healthcare Sector
This year has been quite tough for healthcare organizations not only because of ongoing challenges but a more threatening challenge in the form of the ‘Coronavirus’ pandemic, which is a viral disease that causes widespread respiratory problems such as coughing, sneezing, shortness of breath, body aches, headache, congestion, and kidney failure. The symptoms of Covid-19 can vary from person to person and can be severe.
World Health Organization (WHO) labeled Covid-19 as a pandemic on March 11, 2020, as the number of affected patients and deaths began to rise significantly worldwide. The Coronavirus initially emerged from China but gradually began to spread across the globe mostly because most people were not aware of the severity of the disease. No one in his/her wildest dream could predict that the entire world would go into lockdown, that everything would close down from airports, schools to restaurants and people would start practicing social distancing.
To date, the United States of America (USA) has been one of the most affected countries due to Covid-19. The healthcare centers from big and small hospitals face a crisis situation with an increasing number of patients and the fact that a vaccine that could cure the virus has still not been discovered or developed.
The Growing Challenge for Medical Practices
Medical practices in big urban cities are understaffed and overwhelmed as they have to not only manage patients diagnosed with acute and chronic illnesses but also those infected with Covid-19. The medical practices have to analyze the financial health and the changing costs and regulations concerning Coronavirus diagnosis and treatment.
The bigger issue is to stop further spread of Coronavirus as it’s a viral disease; Covid-19 can easily spread from one human to another. The country is already facing a huge economic crisis due to closed down businesses and people having financial insecurities.
Medical practices are facing difficulty due to lack of resources, and in many places, the healthcare providers have to perform not only their own duties but also manage different administrative tasks as well. For example, healthcare providers have to manage claim processing tasks as well. Healthcare centers have to
- Source for Covid-19 testing kits, ventilators, and medicines
- Get Necessary Personal Protection Equipment (PPE) for healthcare providers and workers
- Figure out a way to manage the overflow of patients
There is so much important information regarding diagnosis, test, treatment, and follow-up that only installing and implementing purposeful medical billing software can help maintain a proper revenue flow. ICD-10 has introduced new codes for diagnosing, testing, and treating Coronavirus patients or patients with Covid-19 symptoms.
Hospitals and healthcare centers face a financial crisis as Emergency Department volume has declined while many thought it would increase. The fear of contacting Coronavirus has prevented or discouraged patients from receiving treatment from health centers. To balance our finances, there has been considerable adjustments in budgeting and forecasting.
How Medical Billing Software has become Imperative in Healthcare
With constant financial certainty, healthcare providers have added responsibility to quickly get payments from insurance companies and reduce the number of denied claims. On average, nearly 5% to 10% of claims are denied, and more than 50% of the claims are rejected due to incorrect medical code. Also, it can take up to $25 to correct each rejected claim and resend it.
A robust and advanced medical billing and coding software is the need of the hour it advantages include
- Automate the entire billing and coding process
- Easy integration with medical practice’s existing management system and Electronic Health Records (EHR).
- Quick entry of patient details and insurance eligibility verification
- With a proper system in place, the healthcare providers would not spend hours to get details from patients and enter them and instead can perform other mandatory tasks.
- The software can easily be updated to include all the sudden changes in ICD-10 codes, including testing, treatment, therapies, and potential vaccine codes.
- The medical codes can easily be selected without the need to spend time and searching amid hundreds of different and complicated codes
- The claims can be processed more accurately and quickly, which will save time, effort, and resources.
- Better analysis of denied claims and knowing where the errors are coming from
- Custom edits which will ease in sending the claims as per type and policies of specific payer and also prior audit and correction before claims are submitted
- Innovative value-added functionalities and features such as remote patient monitoring, Patient portal, Alerts and notifications, Analytics, and reporting.
PETTIGREW is one of the most prominent companies offering complete and purposeful billing and coding solutions to health centers, hospitals, medical practices, and physician clinics. The healthcare practitioners have their work cut out with advanced RCM and billing software and can better cope with pressures and disruptions due to rising Covid-19 infections. An advanced billing software will help a medical practice comply with the changing regulations, optimize the claim processing, manage the operational cost, and get a timely reimbursement.