News Feature | March 3, 2015

‘Behind The Billing Office Door' Identifies RCM Opportunities

Christine Kern

By Christine Kern, contributing writer

Automated Revenue Cycle Management

A NextGen Healthcare report examines the state of medical practice revenue cycle management.

A NextGen Healthcare report based on a survey of several hundred physicians was conducted to find out how healthcare is faring when it comes to revenue cycle management (RCM). The survey, What’s Happening Behind the Billing Office Door, revealed a large percentage of practices surveyed did not meet best practices benchmarks and were missing out on important opportunities for revenue.

“The rationale behind this survey is to assist practices everywhere with the assessment of their own RCM metrics while identifying opportunities to make improvements and optimize revenue,” Monte Sandler, executive vice president of NextGen RCM Services said. “Setting operational best practices can help healthcare organizations quickly identify areas in need of improvement and, with a team of 900+ billing and practice management experts, NextGen RCM Services comprises the right people, processes and technology to help practices best optimize revenue and improve organization-wide efficiency.”

The survey found RCM automation was popular with both in-house and outsourced billing. Cited most often were claim scrubbing (65 percent), tasking staff with A/R and denial follow-ups (55 percent), automatic appointment reminders (47 percent), coding assistance (45 percent), eligibility inquiry checks (44 percent), and reporting (27 percent).

One area that needs more attention by practices is denial resolution. Forty-nine percent of respondents have a single person handling denial resolution and another 45 percent have two to five people. In practices that outsourcing billing, about a third still handle denials in-house, while three-fifths hand it off to the billing firm. Only 15 percent of respondents graded their denial follow-up and resolution abilities as excellent, while thirty-one percent of practices rated their abilities between one and five (out of 10).

Only four percent of practices rated their abilities around electronic claims submissions as “excellent and only 10 percent assigned that rating to their ability to check every Explanation of Benefit and Procedure CPT code to ensure they are paid according to contracts.

And when it comes to payment transactions, 35 percent of practices have a “credit card on file program” to speed payments. Eleven percent of practices say they can get charges entered into the billing system “within hours” of the time of service, while one-third can do it within one day of the service. Fifteen percent of practices believe they are excellent at ensuring that services rendered are billed. Only 10 percent report excellent measures in place to ensure payment according to payer-contracted rates, and 10 percent also reported having excellent measures to check every EOB and every CPT code. On average, 35 percent of patient calls are for billing questions or problems.

An infographic was created highlighting many of the survey’s findings.