High Cost of Deployment to Impede Penetration of Back-end Revenue Cycle Management Services

It’s important to take time to make lasting improvement, not just put a band-aid on for a quick fix. The time-consuming work includes setting goals for performance improvement initiatives, education of staff, regular meetings, performance discussions, and attention to detail on all aspects of the revenue cycle. Partnering with an outsource firm that has expertise in best practices for back-end revenue cycle functions means a lot of that hard work is already done. It also means that the effort can now be expended on improving issues within the revenue cycle.

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Back-End Revenue Cycle Management Roles and Functions:

• Denial resolution and appeals
• Core system management and reporting
• Payment posting
• Under payment analysis and resolution
• Credit balances and refund processing
• Claim submission and claim edit resolution
• Customer service and patient pay
• Insurance accounts receivable follow-up

Back-End Revenue Cycle Management Payment Posting Tips:

• Automate as much as possible
• Identify individual line denials
• Be mindful of secondary and tertiary payers

Credit Balances and Refund Processing Tips:

• Implement a proactive strategy
• Issue refunds within 60 days
• Consider system automation to apply for credits to other services

Back office roles and functions in the revenue cycle are critical to the success of organization. Outsourcing these functions with a partner firm has many benefits. Organizations will have access to potentially cost-prohibitive technologies to help achieve best practices, and resolve any difficulty with recruiting, retaining and educating qualified staff members.

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Geographically, North America is expected to lead the global back-end revenue cycle management market in the forthcoming years. The large share of North America in the back-end revenue cycle management market can be due to the factors such as rising healthcare IT investments in the area. The presence of governing regulations mandates to support market growth in the US. Along with this, increasing digitalization and favorable funding initiatives by the Canadian government is also driving the global back-end revenue cycle management market.

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