For Ophthalmic ASCs and practices, “Efficiency & Predictability” should be the aim of your Revenue Cycle Management (RCM) team. Neglecting your front-end RCM processes will end up costing you (potentially) big $ on the back end. Addressing inefficiencies in your RCM department is an obvious strategy, maintaining a level of predictability represents a more nuanced approach to your revenue cycling.

Efficient, predictable RCM not only improves the financial health of ophthalmology practices, but it can also strengthen a practice’s ability to provide excellent patient care by giving staff more bandwidth to focus their attention on seeing and treating patients. As CMS and private insurers continue to adjust their already complex reimbursement rules and regulations, administrative and billing staff are constantly being challenged to keep up. From provider credentialing and patient scheduling to payments and accounts receivable, staff are often under pressure to maintain efficient, optimized RCM processes.

To combat fraud and waste, federal agencies have started new integrity initiatives, such as the Recovery Audit Program, which are designed to identify incorrect Medicare payments and collect overpayments. These initiatives add further scrutiny to submitted claims, resulting in a 9% increase in Medicare Part B claim denials.1

The ability for a practice’s RCM processes to nimbly adapt and accommodate to this ever-changing landscape can directly impact how much time and revenue is being wasted.

Questions owners should ask themselves: What billing processes can we automate? Does our billing staff have enough time and resources? Are our systems protected from cyber-attacks?

AUTOMATION & EFFICIENCY

The growing need for optimal organization workflow coupled with regulatory reforms and reclassifications is driving considerable growth in the multibillion-dollar U.S. RCM market to the tune of 11% YOY over the next 5-7 years.2 Instability created by the pandemic, including staffing shortages and claim fluctuations, has caused many practices to consider outsourcing their RCM.

Accelerating competition in this space is spurring the development of new third-party RCM solutions, whose businesses aim to capitalize on this growing market. But understanding the evolving intricacies of your practice, staff, and patients will certainly necessitate a customized solution. The right solution should not only aim to increase revenue but also decrease technical errors and streamline engagement between staff and patients.

Transitioning from manual claims transactions to electronic transactions can offer significant savings in time and cost. According to the Council for Affordable Quality Healthcare (CAQF) prior authorization offers providers the greatest time savings potential if conducted electronically, reducing transaction time from 20 minutes to 6 minutes and cost from $7.50 to $1.89.3  

CYBERSECURITY & THE UNKNOWN

Suppose your RCM efficiency optimizations are beginning to pay off, but one day you enter your practice and all your systems are encrypted, what do you do? How long can your business afford to be shut down? Your revenue is 100% dependent on your systems being fully operational.

While automating internal billing processes can certainly save your practice critical time and cost, transitioning to these electronic transactions does not come without risk. The more your patient data is sent and stored electronically, the more valuable your systems become to bad actors and malicious parties.

So, what is the risk?

According to data from the Ponemon Institute, healthcare organizations, for the tenth year in a row, have had the highest costs associated with a data breach: $175 per compromised record.4  This figure only represents the initial cost associated with stolen health records and does not consider the additional time and resources spent on investigating and resolving, which can be devastating to patient care and safety. Following a cyber security incident, the average timeline for an organization to move from occurrence to containment to completed forensic investigation is 49 days.5 So that $175 in damages potentially represents just the tip of the iceberg for an impacted business. As a result, healthcare organizations increasingly rely on the expertise of data loss prevention services (DLPs) to secure and protect their sensitive data.

The National Institute of Standards and Technology offers a Cybersecurity Framework that businesses and organizations of all sizes can implement to improve their cyber posture. Relatively easy measures like two-factor authentication and training staff to detect suspicious emails can help you rest easy. The more proactive your organization is at protecting your networks and data, the more predictable your operational revenue becomes.

Fielding Emmott is a copywriter for Medical Consulting Group.

femmott@medcgroup.com