What happened to the claim?
Did the whole claim get paid?
Is it going to be rejected?
When will the claim be paid?
If you have been asking yourself these questions frequently, then it seems you are ready for a good Revenue cycle management program. The old billing and payment system could be compared to the right hand not knowing what the left hand was doing…and you are left wondering and waiting. This is not the way any medical office can grow and survive.
It is a known fact that providers have been more or less chasing their tails when trying to track down insurance and patient payments. Workflow became stagnant in some cases and even abandoned. This is not an option in today’s reality when cuts are being made to the amounts doctors can receive in many situations.
Having a company that carries out the whole claims procedure makes the office workload much easier. In the new world of medical care, there is a magnifying glass examining each and every test being ordered, every admission to a medical facility, and especially re-admissions. “Why?” is being asked. In this area, physicians have to come up with innovative methods to make their patients more informed about their condition, to better help them understand what they must do to prevent the need for re-treatment or re-admission. So often, patients are not ready to understand their situation at the moment of discharge.
In a report put out by the AMA: AMA Issues 5 Patient Safety Guidelines written by John Commins, for HealthLeaders Media , February 11, 2013 this quote by Grant E. Steffen, MD MA mentions this need of coordination of care.
“Goals can reflect that aspect of care that has been variously called technical or scientific and usually are achieved by the physician’s appropriate choice of tests and therapies. Other goals refer to the nontechnical or interpersonal aspect of care, the art of medicine; these goals usually are not achieved by tests or therapies but by attention to those patient values that generated them.”
There has to be more than just discharge instructions given. A follow-up is needed by an outside agency, family members, or through communication by the doctor’s office. The 5 responsibilities include :
1. Assessment of the patient's health;
2. Goal-setting to determine desired outcomes;
3. Supporting self-management to ensure access to resources the patient may need;
4. Medication management to oversee needed prescriptions;
5. Care coordination to bring together all members of the health care team.
Now with these responsibilities all in place, the need to enforce good revenue cycle management comes into play.