Electronic health record (EHR) software and revenue cycle management (RCM) services are perhaps the most valuable technology any given healthcare practice can utilize. These tools modernize practices, create a more seamless and enjoyable experience for both the provider and patient, and work to maximize revenue and boost cashflow. EHR software has the power to enhance productivity and profitability, as well as provide better patient outcomes.
But…(you knew there was a but) these solutions are only one piece of a much larger puzzle that makes up healthcare technology.
In fact, there is a litany of underappreciated supplemental front and back-office services that can help take your practice to the next level. Services like credentialing, benefits verification, patient call center, worker compensation, out-of-network billing, prior authorization, the release of information, and contract/payor negotiations.
While these tasks are important, establishing in-house support is – oftentimes – too costly and burdensome. That doesn’t mean, however, that enhancing these tasks is out of reach. Here is a look at how ancillary services, provided by industry-leading healthcare IT companies, can help you take your practice to the next level.
Credentialing
Credentialing is the practice of ensuring that physicians have all of the necessary training and experience to safely, efficiently, and effectively practice medicine. This very necessary and required process can be exceptionally time-consuming, which is why it so easily falls through the cracks. Before you know it, your provider’s credentials have expired. Credentialing solutions are designed to help your physicians maintain their credentials with both government and commercial payers, including Council For Affordable Quality Care (CAQH) quarterly re-attestations.
By outsourcing yours or your provider’s credentialing, you ensure that the credentialing process continues unabated. Offloading the stress and burden of maintaining provider credentials can help you focus on more important growth initiatives such as scaling your operations, reducing managerial burdens, or maintaining and attracting new patients.
Prior Authorization
Like many administrative tasks in healthcare, obtaining prior authorization is critical. That being said, the administrative process surrounding prior authorization can be costly and frustrating, and can easily bloat administrative workflows. A common misconception made by front-office staff is that prior authorization is cut and dry. If you know your patient’s insurance policy, coverage for treatment should be relatively easy to obtain from the payer. Right?
The short answer is, not always. Inadequate understanding, or restricted time allowance within your billing department, could result in increased denials that could have been avoided at the prior authorization level. That is why some healthcare IT service providers offer full prior authorization support to help you obtain the prior approval, the first time around.
Benefits Verification
Checking a patient’s eligibility is one of the first steps involved in the medical billing process and is often one of the first hurdles of the patient/provider engagement. To avoid pitfalls and enhance the patient experience, service providers like CareCloud work to ease the administrative burden, reduce mistakes and denials, and overall improve the patient experience. When patients are treated quickly and effectively, with full cost transparency, those patients are more likely to be high-rating, returning patients.
Investing in a service provider who provides complete benefits verification not only reduces administrative headaches, but also leads to enhanced patient satisfaction when eligibility checks are quick and seamless. If you’re looking to invest in a service provider who offers benefits verification solutions, make sure that provider also provides full phone, fax, and email support, so you’re always able to get the coverage answers you need, before point of service.
Patient Call Center
Similarly, partnering with a service provider that provides your practice with an inbound patient call center will take some of the burden off your administrative team, especially when it comes to complicated billing inquiries patients may have. This also keeps overhead costs low and gives you more staffing flexibility needed to grow your practice.
Even better, patient call centers can also take payment from patients on your behalf, which means less time wasted by your staff chasing down unpaid patient bills.
Patient call centers provide practices, like yours, with dedicated experts whose only job is to field billing inquiries, take payment, and mediate defaulted accounts. This can give your organization room to grow, eliminate internal inefficiencies, and boost satisfaction for both patients and staff.
Worker’s Compensation
Workers’ compensation collections can be incredibly difficult to manage for providers due to the special terminologies, unique collection forms, and many legal obstacles. Workers’ comp is extremely specialized and does not follow a single set of rules, as every U.S. state has its own laws and regulations. That can cause a lot of headaches for any billing department.
While it is very difficult to manage, there aren’t that many cases of workers’ comp, as it only accounts for up to 5% of a hospital’s accounts receivable, so healthcare providers rarely allocate additional funds to hire a workers’ comp expert. Instead, rely on service providers to assist workers’ comp submissions through specific payers.
Out-of-network billing
Out-of-network billing can provide a big revenue stream for your practice because they allow you to bill as much – or as little – considering you are not bound by the terms and conditions of a payer contract. However, not having on-hand expertise can delay payments.
With a service provider like CareCloud, everything from sending claims and posting payments, to negotiating the payment from the payer and working with the payer, to paying the negotiated amount, is handled externally. This frees up even more time and money for you to allocate toward bettering patient outcomes. When it comes to out-of-network billing, utilizing a team of experts who can help you maximize your revenues is a no-brainer.
Release of information
Hospitals and health systems are already facing an uphill battle when it comes to managing release-of-information (ROI), including keeping up with the rising number of record requests from attorneys, auditors, and payers, in order to comply with state and federal regulations. Now, this highly complex and regulated process is becoming too burdensome for many healthcare organizations to manage on their own.
Shifting complicated ROI tasks to a team of experts will not only help free up valuable resources, but also keep your team free of legal pitfalls. CareCloud’s Archivus works to simplify the ROI workflow by removing the administrative burden from your shoulders.
Payer Contract Negotiations
Of all the things your practice has to do, negotiating payer contracts could be the most tedious and arduous part of running a healthcare practice. A large part of the success or failure of your clinic could depend on the partnerships – or lack thereof – you have with payers.
Here is the simple truth- there is often more room for negotiations than payers let on. Don’t worry if you weren’t aware of this- many physicians are in the same boat. When you partner with a company like CareCloud, the stress of managing payer relationships and negotiating contracts can be completely avoided. Providers like CareCloud will review existing payer contracts, make recommendations for fees and reimbursement, and keep track of the negotiation progress from start to finish.
If it ain’t broke, don’t fix it.
Getting the proper RCM support, even at the micro-level, is critical to optimizing your growing practice. But beware of healthcare technology providers who use supplemental services — like the ones mentioned above — as leverage to get you to switch your EHR solution. If you’re happy with your EHR solution, you should be able to keep it. CareCloud works with your software system — not against it. That is why it is important to find a reputable, competent healthcare technology provider that will not force a time-consuming EHR transition on you when what you really need are supplemental RCM services that will help you maximize your revenues and grow your business.
Summary
While an EHR solution is one of the largest IT investments your organization will make, it should not overshadow areas where subtle solutions and workflow adaptations can help streamline your administrative processes. Take advantage of dedicated industry experts who are trained to handle the burdensome, time-sucking tasks that are costing your organization money.
And remember, your healthcare IT partner should provide solutions that are flexible, scalable, and work with your workflow, not against it. At the end of the day, you should be empowered to choose the investments that are most needed by your organization.
