Most doctors are in the business of providing quality care, not managing huge administrative operations. So it’s no surprise that running a successful medical practice in the face of mounting administrative pressure and increasing billing complexity hasn’t been easy for physicians.
Important industry changes like ICD-10, pay-for-performance, and Stage 2 Meaningful Use have all caused a growing number of practices to consider outsourcing their revenue cycle management to outside companies.
To help physicians understand this trend, we asked CareCloud’s Vice President of Operations Ralph Catalano, and Director of Billing and Collections Christina Ferreira to discuss the key drivers behind the decision to outsource.
1) What are the benefits of outsourced billing?
Ralph: Outsourced RCM solutions eliminate much of the overhead associated with having to hire, train and retain staff. Instead, practices can use these operational savings to bring on a new doctor or piece of medical equipment.
Tasks like printing paper claims, sending electronic claims, keeping up with payer requirements, and posting remittances are less expensive by scale for outsourced solutions. Handing over these duties to an automated system frees up practice staff to do things like working with patients on engagement efforts, delivering better care, or identifying where the practice should invest for future growth.
2) What are some signs your practice needs to outsource?
Ralph: Right now, practices are facing big challenges like Meaningful Use, reimbursement model shifts, and ICD-10. Many are trying to figure out how they’re going to cope with all of this manually. These are the practices that should consider outsourcing.
Or maybe your practice is fortunate enough to be in a moment of growth, and you’re looking to hire more staff. You may not want to add any more billers and need an administrator instead. We can take the financial burden off of your shoulders, so you can focus on the areas that need improvement the most.
3) How do you know your billing company is obtaining maximum reimbursements?
Ralph: Companies like CareCloud normally have many other clients similar to you in specialty and location. This gives us a larger view into the actual performance of practices. We should be able to give you feedback based on how you’re doing compared to your peers.
Christina: Also, our contract module allows clients to input their contract information according to the codes they should be billing out. If you’re not receiving the correct reimbursement, as per your contract, it’ll pull up any discrepancies in payments and flag them for you.
4) How do outsourcing companies help with ICD-10?
Ralph: Even though your staff will still need to learn how the ICD-10 transition is going to impact proper coding, you can rely on us to handle everything after that. Our system will accommodate both codes, payer by payer until everyone is on the new system.
Christina: We’re going to make sure ICD-10 codes are being mapped correctly. For example, we’ll know when particular insurance companies are supposed to switch over. If one insurance company is going live on October 1 and another on November 1, our system will know exactly when and how to submit claims with both payers.
Also, CMS is creating a whole new HCFA form for ICD-10. An RCM solution is going to make sure all of the new forms are updated in the system and filled out with the appropriate coding.
5) What are some qualities to look for when seeking a good RCM solution?
Ralph: It’s important to know how quickly your vendor can react to change, and how much of the burden falls on you. CareCloud releases new functionality every two to three weeks at no cost to clients. Other vendors only make updates once or twice a year, and then charge you for the release. This just isn’t practical for today’s private practice.
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