Posted by Karen Grace Larsen
In the spring of 2015, Chris Brown, a California-based web developer, sought medical treatment for his depression. Little did he know that his four-week hospitalization would lead to an overwhelming billing nightmare—all because of a single error.
According to Consumer Reports, the hospital’s billing department sent part of the claim to the wrong insurer division. When the hospital didn’t receive the reimbursement, Chris started receiving a cascade of bills ranging from $140 to $11,000 despite having health insurance coverage.
The issue dragged on for over two years, requiring repeated calls, emails, follow-ups, and a detailed appeal before it was finally resolved in 2017.
Chris’s unfortunate experience highlights an important truth about revenue cycle management (RCM):
It’s a highly complex process with far-reaching consequences.
But RCM doesn’t have to overwhelm you and your team. Easy-to-use billing software solutions like IMS help healthcare practices simplify RCM processes, minimize errors, and improve financial outcomes.
Why Revenue Cycle Management Feels Overwhelming
Managing your practice’s finances is challenging enough, but the complexity of revenue cycle management can make it seem insurmountable.
For many healthcare providers, RCM—which encompasses the entire medical billing cycle—becomes a constant balancing act between administrative tasks and quality patient care, leading to overwork and burnout. Here are several factors that amplify the confusion and stress of managing RCM:
1. Disjointed Systems
RCM involves different systems, platforms, and processes to manage a healthcare organization's revenue. If your practice relies on manual processes, outdated systems, and fragmented workflows to navigate something as intricate as medical billing, you could end up in a tangled web of financial errors and patient grievances.
2. Regulation Changes
The U.S. healthcare industry is constantly evolving, and so are billing regulations. Staying compliant with HIPAA laws, payer-specific rules, and coding updates is no easy feat. Without automated billing solutions to keep everything in check, it’s easy for practices like yours to fall behind, get denied, and incur costly penalties.
3. Claim Denials
According to the Healthcare Financial Management Association (HFMA), 90% of health systems cite denials as the top challenge for revenue cycle teams. If your practice handles claims manually, you have a higher chance of getting patient information wrong, making coding mistakes, and missing deadlines, all of which could result in claim delays and denials.
How Automated Billing Solutions Can Simplify RCM
With so many moving parts—claim submissions, regulatory compliance, payment tracking, claim denials, etc.—RCM can quickly bog your team down in endless administrative tasks.
Interestingly, many complex challenges require simple, intuitive solutions. This is where top-tier medical billing software systems come in. Here are three ways an easy-to-use billing software can simplify RCM and streamline billing processes:
1. EHR and Practice Management Software Integration
Fragmented workflows emerge when a practice manages billing, administrative, and clinical tasks across multiple systems that don’t communicate well with each other. The key to avoiding disorganized and disjointed processes is investing in a HIPAA-compliant billing system that seamlessly integrates RCM, EHR, and practice management workflows into one unified platform.
IMS, for example, allows healthcare practices to seamlessly transition from patient care to payment collection without manual errors, unnecessary delays, and miscommunication. Here’s a quick look at how seamless integration within IMS can help simplify your RCM:
| Practice Management |
Your front desk team uses IMS to check the clinic’s calendar, verify the patient’s appointment, and check in a patient. |
| Electronic Health Records |
IMS automatically retrieves the patient’s electronic health records and clinical documents, giving healthcare providers convenient access to the information they need for the visit. |
| Revenue Cycle Management |
Using information from its practice management features, IMS automatically populates the billing module with existing patient information in preparation for the claims process. In addition to pre-linking codes to specific procedures, IMS analyzes data from clinical notes to recommend relevant billing codes, streamline the coding process, and ensure accurate charges. |
2. Up-to-Date Billing Tools
Staying ahead of collection delays, claim denials, and compliance penalties requires having a billing system that can keep up with the latest regulatory updates.
- Payer Criteria Changes: If a payer changes reimbursement criteria for specific procedures, you want your billing software to be able to adjust to them and ensure that your claims are accurate before you send them out. IMS ensures this by providing a dedicated team of billing software experts ready to help 24/7.
- Current Procedural Terminology (CPT) Code Changes: IMS automatically updates your system's CPT codes whenever the American Medical Association introduces new ones. This helps reduce claim denials and costly errors.
- Merit-Based Incentive Payment System (MIPS) Changes: For practices participating in MIPS reporting, IMS updates its report template annually to ensure your efforts align with the rules outlined by the Centers for Medicare & Medicaid Services (CMS). By automating your MIPS compliance process, IMS helps you prevent manual entry errors, conveniently track compliance status, and submit MIPS reports on time.
3. Automate Claims Scrubbing
Claims scrubbing is a process where trained RCM specialists meticulously comb through every claim to check for errors, inconsistencies, mismatched information, or missing modifiers that could cause claim denials or payment delays. While many small clinics still manually scrub their claims before submission, this task is time-consuming and error-prone for larger operations.
If you process large volumes of claims or simply want a more streamlined and accurate RCM process, medical claim automation can help you get more done for less work. Whether dealing with electronic or paper claims, an automated claims scrubbing tool scans all your claims for potential errors before submission.
For example, if a claim is missing a required diagnosis code, an easy-to-use billing software like IMS can flag it immediately and enable you to make the necessary corrections before submission, as opposed to waiting for a payer rejection. This allows you to submit clean claims —ones that payers process and pay the first time they’re submitted.
Cut Through the Maze of Revenue Cycle Management with IMS
Revenue cycle management doesn’t have to be a convoluted mess, and it doesn’t have to overwhelm you. Adopting easy-to-use billing software simplifies your processes, improves cash flow, and reduces the stress of managing your practice’s finances.
IMS’s HIPAA-compliant billing tools and user-friendly interface are carefully engineered to cut through the complexity of modern RCM challenges. With data visibility and process automation, you can navigate RCM with less stress and more confidence.
Don’t let complexity stand in your way—simplify your revenue cycle with IMS today!
