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Meaningful Health Care Informatics Blog

Feb 19 2012   5:15PM GMT

A new breed of revenue cycle management business models to assist independent physicians



Posted by: RedaChouffani
Billing, Collections, IaaS, RCM, Revenue cycle management

As many independent physician groups face the threat of reimbursement cuts, the high costs of software solutions and dwindling referrals, a new generation of billing service providers is offering creative packages and solutions to help these private organizations sustain profitability through new kinds of offerings.

For years now we have seen IDNs and hospital systems joining forces with private physician practices. But for some independent docs, this is raising concerns, as it is affecting referrals and revenue. There are also concerns that they may not have the ability to compete with the marketing dollars, negotiating powers and technology budgets of these health systems and their member practices.

For some revenue cycle management service providers, this was the best opportunity to assist the concerned private physician. The services that are being offered are tailored to help eliminate some of the typical challenges that small to mid-size physician practices face. Some of these include:

Hosted practice management and EHRs: Some of the companies have eliminated the high up front capital costs associated with a purchase of EHR and PM. By offering a full platform with services, a physician group can pay a monthly fee or part of their reimbursement and receive a fully operational PM/EHR system.

Revenue cycle management (RCM): Many of the RCM firms offer as part of their services some of the following:

  • Fully outsourced billing and collections
  • Coding solutions to increase reimbursement
  • Improved cash flow and collections
  • Lower overhead
  • Reduced bad debt

Technology: Technology has been a new territory for many of the billing service providers. By including hardware or infrastructure as a service (IaaS) options, many of their clients have the advantage of receiving support and services from one single group. This also provides a much more predictable cost and fee structure for an organization.

Consulting: For healthcare billing groups, their financial revenues are directly associated with the client’s reimbursements. This means that they are incentivized to get the highest reimbursements and are continuously working with physicians to assist them with coding challenges, as well as helping identify efficiencies and value-added solutions.

Portals: Payment and referral portals have been a new addition that many of the billing firms have started to adds to their offerings. This significantly improves cash flow as well as allows for all of their clients in a community to interact with each other and share patient information electronically.

Compliance: With all many of the pay for performance (P4P) programs available, as well as meaningful use and other federal programs, billing firms are helping physicians receive some of the incentives available.

It seems that in the past, most of what has been written about the revenue cycle sector has focused on the outsourced collections and billing aspect of services. There are many new RCM providers that are bundling additional services that bring tremendous value to independent physicians. Despite the current complexity and changing landscape of health care, many physicians are able to focus on patient care while having increased assistance in their revenue cycle management from the front to the back.

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