According to a Forbes report, it was estimated by Statista that the US market value for health and wellness would rise from $166.5 billion in the year 2015 to $179 billion in 2020. The report further quotes research that estimates the growth of the retail health clinic market at a combined rate of 18.3% between 2019 and 2030. When the report was published, however, the crushing effects of COVID-19 had not yet been documented.
Certain challenges that were faced before the COVID-19 pandemic remain unchanged for the HME/DME business. One of these remains – effective Revenue Cycle Management or RCM.
Transparent reporting is the result of a well-managed revenue cycle. For most healthcare businesses though, the focus remains on meeting client commitment and delivering best value to customers. This is likely to take focus away from business operations. Most healthcare businesses are paid through reimbursements. This means a lot of back-and-forth paperwork and verification, which can negatively impact business cash flow.
Why Focus on RCM?
The revenue cycle for your business begins at patient registration and ends when all payments are made. This increases the importance of effective documentation and recording right from registration, scheduling appointments, verifying insurance, etc.
The next critical part within a revenue cycle is claims submission, as well as management of claims denials. Unlike patient registration and insurance verification — which may be efficiently handled in-house — claims submissions and denials are driven in large part by external factors. As a result, reimbursements may get delayed by factors beyond your control. To ensure timely payments, it is important to pay attention to both internal and external factors, such as successful management of overdue Accounts Receivable (aging AR) and claims denials.
Getting paid is still a priority. Not getting paid or facing too many claim denials can affect chances of business survival. Fortunately though, sound financial management practices can go a long way towards ensuring sustainability for a HME/DME business. RCM is a crucial aspect of medical billing, and if managed well, can result in transparent reporting.
Critical aspects of claims submissions, denial management, and diligent Accounts Receivable follow-ups are all part of the process needed for transparent reporting.
Claims denial is a reality; choose to get help with it
Managing claims denials is a critical aspect of RCM. It requires a detailed understanding of industry practices, regulatory requirements, and negotiation. Professional help with claims denials can ensure that the business gets paid.
With help, move from sustainability to successAt Analytix Solutions, we offer HIPAA-compliant medical billing solutions. We have worked closely with startups and small businesses, helping them streamline operations and develop better financial management systems. We can help your business better manage your revenue cycle. Improve your collections and more towards a more transparent system of reporting to ensure your success is consistent and repeatable. Email us at [email protected] or call 781.503.9002 to learn more about how we can help you with RCM.