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    Physicians need to be vigilant when choosing RCM solutions

    Small physician practices can expect their IT vendors to add new revenue cycle management (RCM) tools that will improve patient billing processes. But physicians shouldn’t expect technology alone to solve all their problems.

    In fact, physicians should be cautious when vetting RCM software, warns Mutaz Shegewi, research director covering provider IT transformation strategies at IDC Health Insights, a division of Framingham, Mass.-based IDC Research Inc.

    At a time when many physicians struggle with inefficient billing processes that often contain errors and are labor intensive, Shegewi said doctors are increasingly looking for systems to simplify bridging the patient encounter with administrative data to streamline payment.

    Implementing RCM systems are gaining a renewed sense of urgency as small physician practices enroll in programs like Medicare’s Quality Payment Program, including the Merit-based Incentive Payment System, as well as other pay-for-performance initiatives.  In this environment, Shegewi said, physicians are demanding RCM tools to automate financial processes and medical billing tasks.

    “Typically, vendors offer physician practices everything beyond the patient encounter, including scrubbing the codes, generating and submitting claims, and then posting the payment to the practice. In return, vendors ask for a percentage of the practice’s revenue and for some practices that’s a very appealing offer,” Shegewi said.

    However, this arrangement comes with many challenges because oftentimes vendors and their clients don’t communicate effectively and set the right expectations, Shegewi said. He added that too often, practices think if they do nothing beyond the clinical aspect of the patient encounter and outsource RCM to the vendor, they have no role to play. This view, however, causes problems.

    “There are best practices that need to be followed to facilitate the billing process. For example, there are coding processes and tasks that need to be streamlined to ensure practices properly code items prior to the end of the encounter, which with the aid of the vendor and their capabilities can be identified and continuously improved on,” Shegewi said.

    Next: Four strategies to improve RCM operations


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