Is it Time to Integrate Revenue Cycle Management Systems Into Your Practice?

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With the October deadline for ICD-10 transition looming, now might be the time to consider integrating current electronic health records systems with clinically-driven revenue cycle management (RCM) software. By integrating the two systems, oncology practices can optimize revenue streams at the point of care, speed up reimbursement, minimize denials, and streamline the collection process, according to a white paper by Greenway Medical Technologies, a company specializing in electronic health records and practice management software. The paper titled, “Applying Health Data Liquidity Within the Provider Organization to Improve Clinical and Financial Outcomes,” is available .

The transition to ICD-10 itself could cost physicians from $83,000 to $2.7 million per practice, with potential losses and delays in reimbursement due to incorrect coding a distinct possibility, according to the American Medical Association. The Centers for Medicare & Medicaid Services (CMS) estimates that physician offices will spend 3% of annual revenue in the ICD-10 transition, which can add up significantly based on the size of the organization.

For the integration between existing EHRs and a newer RCM, Greenway says that physician training, clinical documentation improvement, and updating forms should be considered, but that the “majority of transition costs will be in software upgrades, IT systems changes and associated staff training.” Greenway further states that “the CMS cost estimate doesn’t address providers’ greatest concerns—of reduced or delayed reimbursements due to miscoded claims, lost productivity and reduced patient capacity because of the complexities of the ICD-9 to ICD-10 transition.”

Perhaps the biggest benefit of integrating the two systems is to minimize the rate of denials for claims and reimbursements, states Greenway. Billing services focus on claims and collections at the end of the patient care cycle, but as much as 30% of claim denials occur because of errors or omissions before that stage of the billing cycle. By providing data to the provider at the point when a clinical decision has to be made, an integrated system can help prevent denials—and support resubmissions when denials occur.

A clinically-driven RCM holds many advantages for the provider and the billing department.

For the provider:

• An RCM can send alerts when a requested procedure or test won’t be reimbursed by the payer. Alerts can also flag duplicate procedures and tests
• Alternate procedures or tests can be recommended over an initial, non-reimbursable choice
• As the system adapts and rules are added, an RCM can recommend proven means for improving clinical and financial outcomes

For the billing office:

• First-time payment rates can increase because data are complete and auditable
• Real-time data flow from the EHR to the RCM solution reduces cycling time, with submissions getting to payers and patients more quickly

When claims are still occasionally denied, faster and more accurate processing with clinical documentation supporting claims can speed up