Revenue cycle management (RCM) is the backbone of practice success. However, the revenue cycle is notoriously difficult to manage and optimize in orthopaedic practices, with threats to revenue growth hiding around every corner. Shielding your bottom line from revenue loss is no simple task, but the best place to start is an end-to-end assessment of orthopaedic revenue cycle roadblocks. 

Evaluating Hurdles in the Orthopaedic Revenue Cycle

Building a consistently profitable revenue cycle may seem impossible in today’s healthcare climate, but outsourcing to a medical billing expert like Med USA can help close the gaps in:

1. Registration and Scheduling. Getting your practice paid starts with collecting the right patient information, including insurance changes, address updates, and other financial and demographic information. Patient scheduling is the perfect time to gather this information. However, an overstretched billing team is often too busy to complete this process thoroughly. An extra pair of hands can help streamline this step and set your revenue cycle up for success.  

2. Patient Eligibility Verification. After registration is complete, the next step is verifying insurance eligibility and obtaining prior authorizations before the patient arrives. Outsourcing this step not only alleviates the administrative burden from your team but also ensures your billing process runs smoothly and your reimbursements arrive on time.

3. Coding and Documentation. Orthopaedic practices bill for intricate procedures and diagnoses, calling for proper documentation of patient encounters and a comprehensive understanding of coding requirements. This level of granularity and coding complexity can easily confuse an in-house billing team, resulting in unclean claim submission and critical revenue leakage.

4. Charge Capture. Once codes have been assigned to services rendered, the next step is creating charges to be billed. This step, in addition to coding assignments, is vital for your team to receive proper reimbursements and avoid unnecessary claim denials. Outsourced specialists guarantee accurate charge capture and prevent revenue loss from common in-house mistakes like undercharging or overcharging.

5. Claims Submission. After charges have been assigned for a patient encounter, claims are submitted to insurance companies. Like every step in the revenue cycle, timeliness and accuracy are paramount in the claims submission phase. If your billing team is overextended, this step might be delayed or performed incorrectly, resulting in late payments, low reimbursements, and climbing A/R days.

6. Payment Posting and Reconciliation. Reimbursements must be posted and reconciled against each claim to ensure payment accuracy and identify discrepancies. This process is time-consuming and error-prone for in-house teams. An outsourced RCM expert like Med USA has the depth of knowledge to ensure your practice receives the correct amount owed by immediately searching for underpayments, overpayments, or payment denials. 

7. Accounts Receivable Management. Managing A/R is an ongoing and resource-intensive task for in-house billing teams requiring continual follow-up on unpaid claims, denials, outstanding patient balances, and aging reports. Outsourcing this step guarantees accuracy and minimizes A/R days by leveraging expert help to conduct follow-ups and troubleshoot repeat revenue loss.  

8. Patient Billing and Collections. Collecting insurance reimbursements is often more straightforward than collecting patient payments. Maximizing patient-pay revenue requires transparent communication, timely statement submission and follow-up, as well as flexible payment options. Without specialized tools and expertise, in-house billing staff struggle to keep patients engaged long enough to pay in full.

9. Reporting and Analysis. Healthcare analytics and business intelligence tools deliver highly valuable insights into practice financial performance. An outsourced team can dig through your medical billing software to generate regular financial reports and track KPIs (including A/R days, denial rates, and collections efficiency) to gauge revenue cycle health and create data-driven business recommendations. 

A Simple Solution to Optimize Your RCM

Each step in the revenue cycle requires close coordination and collaboration, making RCM as a whole a challenging road to navigate for your billing team. This task becomes even more difficult with an understaffed or inexperienced billing office, which is a reality for many practices. In 2022, over 90% of practices reported staffing shortages in their billing department.¹ One year later, an estimated 63% of practices continue to struggle with understaffed revenue cycle offices.² 

Without an efficient revenue cycle, billing teams jeopardize the bottom line and undermine practice growth. An outsourced RCM and medical billing expert like Med USA can help close the gaps in your revenue cycle with data-driven solutions proven to improve profitability, increase patient satisfaction, and position orthopaedic practices for long-term financial success. 

Want to Learn More About the Benefits of Partnering With Orthopaedic RCM Experts?

Contact a Med USA representative today!

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Sources

1. 2022 Mid-Year Healthcare Financial Trends Report. (2022). R1. https://www.r1rcm.com/2022-healthcare-financial-trends-report?hsCtaTracking=f45597da-b391-4ca8-979c-357ad5f75016%7Cc69da288-ce76-40f8-8ccd-967ecae1be51 
2. Synchrony. (2023, April 6). Study Finds Healthcare Providers Looking to Outsource Revenue Cycle Management Processes [Press release]. https://www.prnewswire.com/news-releases/study-finds-healthcare-providers-looking-to-outsource-revenue-cycle-management-processes-301791790.html