RCM Tip #3: Prioritize Outstanding Claims

Utilize gastroenterology practice management and revenue cycle management solutions to strategically manage claims.

In 1906 Italian economist Vilfredo Pareto observed that 80 percent of the land and wealth in Italy was held by 20 percent of the population. Over time this statistic was observed in many different facets and has become a common rule of thumb, known as the Pareto Principle. The theory is that 80 percent of results will come from 20 percent of the efforts. This well known statistic in the business world can apply to your gastroenterology medical billing process as well, where 80 percent of your collections come from 20 percent of your billing efforts.

In general, most medical practices approach all claims in a similar manner regardless of the claim amount, payer or complexity. That’s not to say you shouldn’t pursue 100 percent of your outstanding claims, but with time and resource constraints, you should focus on those that have the highest likelihood of payment and are easiest to submit.

You should prioritize and categorize your outstanding claims by claim amounts, common services and codes, insurance companies, missing information and other factors your staff can more easily manage. It should become clear through this process which claims can be easily submitted with a better chance of successful payment and which claims require additional effort or have a higher likelihood of denial or rejection, which will take even more effort for your staff to resolve.

Benefits of an Integrated Gastroenterology Practice Management System

Your gastroenterology practice management system should be a vital tool in helping you and your staff prioritize claims. With an integrated practice management solution, the clinical information from your EHR system flows seamlessly into the practice management system, streamlining the gastroenterology billing process and creating a more comprehensive financial picture.

How Our Gastroenterology Software Solutions Can Help

Modernizing Medicine® Gastroenterology’s Practice Management System, gPM™, supports a gastroenterology billing workflow with financial dashboards, task lists and reporting tools. With gPM you can easily sort your claims in process by various criteria such as status, amount, payor, etc.

Another great feature is the ability to delve into staff productivity trends, where you can identify who is working on which claims and how much is being collected. This unique feature can help you identify your experienced billing staff, who can in turn share best practices with other staff members. You can also create individual work lists for your staff members to help manage workload among your office staff.

With more of the financial responsibility shifting to the patient, collecting from your numerous patients can be time consuming. The ability to easily create, manage and distribute patient balance statements through the patient portal can help save staff time and resources.

Additionally, with robust analytics and reporting tools you can visualize your financial data with a variety of tables, charts and graphs. You can track trends in your collections such as month over month changes in accounts receivable, charges by CPT or ICD-10 codes and payment distributions by payor or provider. You can also compare your financial metrics to industry standards and other Modernizing Medicine Gastroenterology clients.

Having a practice’s financial and operational data at your fingertips may reveal valuable insights about your collections process, helping you prioritize your outstanding claims and improve your billing process efficiencies.

For a more detailed look into what our gPM software has to offer your gastroenterology practice, watch our recorded practice management webinar.

Implement Gastroenterology Revenue Cycle Management Services

Smaller medical practices may not have the people, processes and technology in place to effectively implement a claims prioritization strategy. That’s where comprehensive revenue cycle management solutions—backed by experienced gastroenterology billing professionals—can dramatically help.

Coupled with gPM, our gastroenterology Revenue Cycle Management (RCM) service provides a fully integrated solution that addresses your revenue cycle needs from before the patient is seen until after the bill is paid.

Gastroenterology billing and revenue cycle specialists focus on managing your claims process, including claim scrubbing, submission and assisting with denial or rejections. They can further help your staff with patient collections by providing patient statements, placing automated outbound calls, handling inbound patient inquiries and processing patient payments for your practice.

With this workload lifted off your staff and placed with an experienced gastroenterology team, you and your staff can focus on providing top notch patient care and growing your practice.

Here’s what a client has to say about our RCM services:

“The RCM team has been instrumental in helping improve our practice workflow and collections. Their attention to detail and dedication has helped our practice obtain optimum efficiency, and we cannot imagine running our practice without their services, “ shared Roger Kao, MD, of Digestive Care Medical Center and Digestive Care Associates.

Patrick DeAngelo

SENIOR VICE PRESIDENT AND GENERAL MANAGER OF BUSINESS SERVICES