How Revenue Cycle Management Helps You Collect What You’re Owed

by Ales Cejka | Jul 12, 2018 |

Going above and beyond dermatology medical billing with RCM

Physicians in the U.S. lose an estimated $125 billion—yes, billion—in revenue each year simply due to ineffective medical billing processes. Why? Because most outsourced billing companies and in-house dermatology billing staff don’t understand and address the entire revenue cycle. More than ever, it’s important for medical practices to consider a revenue cycle management (RCM) which goes above and beyond a dermatology medical billing service to provide you with the people, processes and technology to help you gain greater control of your billing operations, maximize your collections and improve your cash flow.

Tying Together the Revenue Cycle

The RCM process begins the moment a patient schedules an appointment for your services and is complete when you’ve received full payment for those services from insurance and/or the patient. Needless to say, there are several steps and variables between those points in time that require attention, expertise and follow-through. Too many practices compartmentalize RCM into discrete functions, often using disparate systems, that lead to disjointed processes and delayed or no payment. This can have a significant negative impact on your cash flow, bottom line and overall practice success.

A sound RCM solution unifies the key components of medical billing—practice management, electronic health records and claims processing—to create an efficient workflow that gets you paid the money you are entitled to collect, while enhancing the overall patient experience.

Step-by-Step RCM Process and Dermatology Billing

Below is a detailed, step-by-step process of an effective, integrated RCM workflow and service. Following this process can help your claims have a high likelihood of being paid in full upon first submission:

Eligibility Verification—Before the patient appointment, your dermatology practice management system automatically checks patient eligibility to reveal any issues in advance that will prevent you from getting paid.

Appointment Reminder—The RCM system can deliver automatic text or phone call reminders (e.g. two days before appointment) to help minimize missed appointments and “no shows.”

Patient Check-In—Upon arrival, the patient is checked in to the practice management system.

Superbill Creation—The integrated electronic health records (EHR) system automatically suggests codes and modifiers, based on the service, procedure or treatment, to help claims get submitted correctly the first time.

Claim Entry—The dermatology practice management system “scrubs” your claims for accuracy, leading to faster and full payment.

Patient Checkout—Upon patient checkout, the practice management system displays patient co-payments and deductibles to facilitate up-front payment so you don’t have to collect later.

Claim Review and Submission—The RCM team, comprising medical billing experts, reviews your claims once more before submitting to the clearinghouse.

Claim Acceptance—If submitted accurately and “clean,” the clearinghouse accepts and submits claim to payer, who then accepts and sends payment.

Claim Rejection—If the clearinghouse rejects the claim, it is returned to the RCM team for correction and resubmission.

Payment Receipt—All payments are transferred into your bank account from your electronic lockbox. You just got paid!

Payment Posting—The RCM team posts payments in the practice management system, providing you visibility into your collections and Explanation of Benefits (EOBs).

Balance Paid—Congratulations. You have collected what you’re owed from the payer, resulting in “zero balance.”

Patient Balance—To help you collect any remaining balance billed directly to the patient, the RCM solution provides detailed patient statements, automated patient calls, live patient calls, inbound call handling and an online patient payment portal.

Account Reconciliation—Once payments are posted, the RCM team reviews the account to check if everything adds up by comparing the charges sent (claims) with the payments received.

See a visual representation of how you can get paid faster, increase income, free up time and gain peace of mind.

Elements of Successful RCM and Dermatology Medical Billing

Throughout the entire process described above, it’s critical that your dermatology billing professionals are applying the experience, expertise and transparency to provide you with visibility and control over your financial operations. When evaluating an RCM outsourcing company to handle your dermatology medical billing, be sure to look for:

  • Specialists providing personal support
  • Detailed reports revealing insights
  • Claims management system creating transparency
  • “One-stop-shop” solution making life easier

Ready to discuss your RCM needs and how Modernizing Medicine can help you collect more of what you’re owed? Contact us today for a free cash flow analysis that can help identify gaps and opportunities in your medical billing process.

Ales Cejka

Ales Cejka

Vice President of RCM Services

As Vice President of RCM Services, Ales Cejka leads all aspects of the company’s and its subsidiaries’ revenue cycle management (RCM) operations, which include billing and collections for participating physician practices.

Ales brings years of experience in medical coding, auditing and RCM operations. He previously worked as Vice President of Operations for MedData, a leading provider of technology-enabled healthcare services designed to improve financial outcomes for multi-specialty physician groups, as well as hospitals by enhancing the patient experience and expanding their access to healthcare. Ales received his degree from Charles University in Prague.

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