Revenue Cycle Management
Better Processes For Better Experiences
Can you keep track of every health insurance provider your patients use? Do you know every patient by name and medical history?
In a small private medical practice, it may be feasible to know each of your patients that well. But for most medical practices and hospitals, it likely feels impossible to even know all the health insurance providers out there, let alone all of your patients. Yet, it’s important to create a positive experience from the moment of a patient’s initial contact. Not only does it improve the chances that patients will return, but that positive experience can help make the insurance claims and billing process easier. So, with that in mind, how is your hospital’s or medical practice’s revenue cycle management?
Healthcare revenue cycle management systems are there for more than just information tracking. They can help you start off on the right foot with each patient, collect all the information your team needs, and provide better, more personalized care. Of course, good RCM solutions also help you to capture pertinent information, check insurance coverage, categorize treatment, and streamline the billing process. Ultimately, the less time your staff needs to spend making calls and chasing down information, the faster patients can get the care they need and the more time your team will have to focus on providing that care. Revenue cycle management allows you to put the focus on your patients, not the headaches and hassle of medical coding and billing.
Our RCM Solutions
The AuthNet team specializes in handling the details of revenue cycle management and insurance prior authorization. We’re here to take care of the behind-the-scenes billing and insurance information to keep in compliance and help your practice run smoothly. We will take care of the calls and coding so you can focus on caring for your patients.
The AuthNet team will take care of verifying:
- The type of policy and plan or insurance ID number and group number
- Employer information
- Policy start and end dates, in-network/out-of-network deductibles, co-insurance, or co-pay
- Out of pocket expenses, age or service limitations, and plan exclusions
- Maximum benefits, including max visits per year and total lifetime dollar value
Once we finish with the initial verification, our work doesn’t stop there. We will take the time to dig into any CPT codes that will require insurance authorization before care. Then, we will open a case with the authorization department of the patient’s insurance and take the time to provide any necessary supporting documentation. After the prior-authorization process is started, we guarantee a 24-48 hour follow-up to check for approval — that’s right, no sticky notes or reminders to follow up needed on your part.
After receiving the necessary medical preauthorization, we will send you the authorization number and either update that information in our RCM portal, or we will update the information in your billing system. If for whatever reason, the request is denied, we will handle the follow-up, provide additional information, clarify details, and otherwise do our best to get authorization. If the insurance provider needs to review the information with the physician before providing authorization, we will update your billing system or our RCM portal as appropriate to coordinate the details needed to facilitate that conversation. In essence, we take care of all the digging and all the details to provide insurance precertification so your team can focus on providing the care your patients need.
Healthcare RCM Benefits
Outsourcing your prior authorization process provides myriad benefits for your medical practice or hospital billing team as well as for your patients. Here are some of the most common perks you can enjoy when you work with an insurance preauthorization and healthcare RCM like AuthNet:
Focus On Patients
Let’s face it, your medical staff don’t want to bother with the hassle of dealing with precerts; they want to provide care to their patients. We handle the details so your team can focus on what you do best: provide better care.
Minimize Billing Errors
We are medical RCM and insurance precertification specialists. Our team has extensive knowledge in navigating health insurance policy details and precertification requirements. Our knowledge and diligence help keep billing errors to a minimum.
Think about what a hassle it can be to train someone new on the ins and outs of insurance precertification, the amount of training necessary to keep up with procedural changes, and how much all of that costs your practice. We keep up with the training and changes so your administrative team can focus their energy elsewhere and keep everything running smoothly.
Each time a patient shows up for an appointment without a necessary insurance pre-authorization, it slows down your office and makes a hash of your carefully balanced schedule. We’ll manage the precerts to minimize schedule disruptions, help your patients enjoy timely care, and make better use of your staff’s time.
Improve Patient Experience
When a patient can walk in, get checked in, and move straight into their scheduled appointment, that goes a long way toward a better patient experience. Let the AuthNet team handle the insurance prior authorization so you can focus on each patient’s care.
No one can possibly keep track of each change of code or policy between Medicare, Medicaid, and other health insurance providers. We keep on top of those details so you can remain in compliance without worry (or tons of hassle).
Grow Your Practice
Our goal is to not only provide timely and accurate insurance precerts, but we also aim to make the billing process easier. We work to improve payment cycles and insurance reimbursements so you can take that better bottom line and put the focus where it’s needed to grow your healthcare center.
In-House Versus RCM Services
Billing and revenue cycle management are, arguably, the most important part of a medical practice or hospital — after the doctors and nurses providing care. An insurance preauthorization failing to go through before a patient’s appointment can do more than throw off the day’s schedule; it can impact billing timeliness, insurance reimbursements, and the overall cash flow for your practice. Of course, every clinic, private practice, and hospital’s operational needs are different. While a revenue cycle management service like AuthNet may help you improve that aspect of your business, it’s up to you to understand what your practice needs.
Keeping your RCM needs in-house means retaining a greater level of control over that side of your practice. The flip-side of this, however, is that it’s up to you to keep those employees up-to-date on their training. It also means covering the expense of salaries, benefits, and necessary equipment. If your practice has recently trained medical billers and the purchased appropriate equipment, the savings of switching to RCM billing services may not be there — at least, not until it comes time to train new staff and replace equipment.
The other issue to consider is proximity. In-house medical billing means you can walk to the appropriate office if issues arise. In this day and age, however, technology often makes that a minor concern. Often, the downsides of having a team in-house negate the benefits. For example, medical billing departments are often subject to fraud and embezzlement without someone to keep a close eye on the team. Then, there is the question of support when one of the staff is sick or goes on vacation. Who will pick up the extra work?
Outsourcing insurance pre-authorizations and medical billing tasks to a revenue cycle management service is a great way to fill the gaps without detracting from your practice’s overall operation. It is a less hands-on option than in-house staff, but the benefits often outweigh that change in procedure. Healthcare RCM companies, like AuthNet, make it standard practice to keep up with any necessary training, policy updates, and equipment changes so you don’t have to worry about that expense. Even better, most revenue cycle management companies will provide a certain level of service — including appealing precert denials — because it’s a service included in your agreement. That’s less hassle for you and your patients to ensure that every step is being followed and all necessary information is being provided to obtain an insurance authorization. RCM companies also handle following up with the insurance company and providing additional information as necessary. This frees up your staff to focus on the day-to-day operations of your practice and providing better patient care.
A healthcare RCM can provide the additional help support your practice needs to streamline the prior-authorization process while improving reimbursements and profits. Want to know more? Explore our insurance precertification process, or give us a call to discuss your practice’s specific needs and details with our RCM solutions team. We’ll run an ROI analysis, provide a demo of our services, and answer any questions you have. So what are you waiting for? Contact the AuthNet team today and see how our specialized RCM solutions can help improve your medical billing processes.