eBook - NextGen RCM Services - 7 Secrets to Getting Paid


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Learn how successful practices get paid faster: Read seven reasons why top practices choose NextGen RCM Services for their billing partner.

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eBook - NextGen RCM Services - 7 Secrets to Getting Paid

  1. 1. SEVENSEVEN SEVENSEV Why top practices hand off billing to NextGen RCM Services Seven secrets to getting paid
  2. 2. “Revenue cycle management work takes diligence to succeed. NextGen RCM Services digs into the detail to truly understand the issues and works closely with us to optimize collections. Whatever is needed, we can count on NextGen RCM Services. ”Michael McManus, Chief Operating Officer Touchette & Kenneth Hall Regional Hospitals
  3. 3. secrets There’s too much at stake to let administrative burdens hamper your ability to practice medicine and financially thrive. With Meaningful Use (MU) Stage 2, ICD-10, and an ever-changing healthcare environment, it’s essential to have a proven technology solution and partner that supports your regulatory readiness and helps you resolve billing issues. The right experts and technology will reduce your administrative headaches and ensure you get every dollar you deserve.
  4. 4. Find a tailored billing solution packaged in a flexible service model to get support where you need it most. 1
  5. 5. Is your practice struggling to handle time- consuming tasks associated with medical billing? In today’s complex healthcare environment, many practices are struggling with medical billing and recruiting the talent required to stay on top of billing rules. Outsourcing a part of the billing process doesn’t need to mean downsizing staff or handing over complete control of Accounts Receivable. Services like NextGen® Revenue Cycle Management (NextGen RCM) offer a tailored billing solution with the flexibility to add resources only where you need them to fix revenue leaks and optimize your bottom line. NextGen RCM experts can help with as much, or as little, as needed. In some cases, your practice may be growing faster than your internal billing staff can handle. Or, you may not have the physical office space or the full back office infrastructure needed to support the volume of claims and credentialing associated with such growth. Even if you’re not growing rapidly, NextGen RCM Services can help you retain your staff in the face of change and intelligently re-engineer employee responsibilities for optimal financial results. With a tailored solution, rather than taking over the jobs of your current staff, you gain expertise and support for time-consuming, repetitive billing tasks. This allows internal staff to focus on higher value activities that can help maintain and improve A/R, as well as more time to focus on care. While partial medical billing service packages are a good choice for many practices, they may not be the best choice for all. It may be more beneficial for a practice to allow a medical billing service to actually “become” their billing office, managing the entire claims process.  
  6. 6. Choose an integrated solution that covers the full RCM cycle 2
  7. 7. Do you have all the pieces in place for a healthy bottom line? According to the Healthcare Financial Management Association, RCM involves managing both administrative and clinical functions related to patient services. But not all billing solutions cover the full RCM cycle. It is inefficient to switch from an RCM system to a practice management system, and then, later, open your EHR. A truly integrated system combines all of this functionality in an organized chronological order to improve workflow and staff time spent on back end office issues. This, in turn, will improve your bottom line. NextGen RCM billing services provide you with everything needed including EHR, Practice Management, Patient Portal, and appointment reminder systems. With NextGen RCM Services, our experts ensure you’re taking full advantage of top tier medical technology to drive revenue to its fullest potential. Performance is based on more than just the ability to manage A/R. A one-platform approach connects and synchronizes the clinical, administrative, and revenue solutions across all areas of a practice. From the configuration of appointment reminders and eligibility verification tools to claims processing, NextGen® technology is configured efficiently — accelerating revenue while saving time and money. Denials and appeals are reduced significantly through tools like NextGen® Real Time Edits (NextGen RTE) providing access to thousands of the most current payer rules, enabling claim “editing” to be invoked during the billing process. NextGen RCM Services experts make sure required edits are applied, ensuring all claims are accurate. As a result, billing conflicts are addressed immediately. With outsourced billing, you can take advantage of our top tier technology, dashboards, tailored processes, RCM best practices, and the advanced reporting you need for complete control and A/R transparency. NextGen RCM Services deliver streamlined billing processes and proven methodologies tailored to your practice. These methodologies are easy to navigate and give you a clear picture of how fast you are getting paid, who’s not paying you, and why you’re not getting paid.
  8. 8. Pick a solution that supports MU2 and ICD-10 readiness. 3
  9. 9. Is your technology partner MU2 certified? Are they ICD-10 ready — and helping you get there, too? The majority of EHR companies offering integrated billing services are not MU Stage 2 ready. NextGen Healthcare is committed to helping clients meet ongoing ICD-10 and MU goals—and offers the award winning technology needed to help you get there quickly. As one of the first three EHR companies in the nation to have an ONC Certified HIT 2014 Edition solution, we’re built to manage change and keep you ahead of regulatory demands and risk-based payment models. NextGen Healthcare is an industry leader and a safe, proven choice in times of rapid change and uncertainty. Your technology partner should demonstrate a commitment to client partner- ships and proven solutions to help you secure stimulus incentives and meet regulatory requirements. To date, NextGen Healthcare clients have claimed over $440 million in MU payments. It is also important to look at the overall national rankings of successful attestations, as well as the attestations success rates for your specialty areas. Our proven robust system, with strong clinical/specialty content, can help your practice fully meet MU attestation requirements. We are consistently ranked in the top four by CMS. NextGen Healtchare is built to manage change. ONC Certified HIT 2014 Edition and MU ready! Our ICD-9/ICD-10 Comparison Utility helps clients evaluate if, and where, they need additional training on the new codes. 3
  10. 10. 4Demand an RCM partner with proven results.
  11. 11. Does your prospective partner boast impressive outcomes? A high-quality solution will revolutionize the way your company operates and help you achieve greater efficiency and better financial results. With a top-notch billing service like the one of- fered by NextGen Healthcare, you can expect to reduce average A/R days by 36% - 37%, to improve collections by 9% or more, and achieve a first-pass clean claim rate of 97% or higher. Your billing provider should be able to produce case studies and proven metrics from actual customers showing measurable results. NextGen RCM experts can deliver success stories and offer a free assessment to help you assess your revenue cycle and practice performance against state and national averages and identify RCM improvement opportunities. Our Clients Realize Amazing Results IASIS Healthcare • 33% improvement in first-pass clean claim rate • 9% reduction in denials • 42.7% increase in cash collections Capital Women’s Care • 81% decrease in A/R days to 21.47 • 99% Net Collections Rate • MGMA top performer Cincinnati Children’s Hospital • Decreased A/R days to 20.31 (MGMA average 45.93) • 89.6% of collections received in less than 30 days • Aged A/R less than 1.79% “We thought we were doing well with our clean claims rate before but NextGen Billing Services increased our clean claim rate more than 20 percent. ”Elisabeth Duhon, Director Revenue Cycle Management
  12. 12. 5Reduce your administrative headaches with an RCM partner that quickly resolves issues.
  13. 13. “It starts out with RCM Services working the denial as much as possible and fixing it. Issues such as inconsistent insurance info or mismatched providers... are identified and NextGen RCM Services takes care of it. With RCM Services, follow-up time is as quick as possible. They do an excellent job at resolving situations. ” Keith R. Froleiks, COE, CMA, Practice Administrator Would you like to spend more time practicing medicine? Many RCM service providers say they will reduce headaches and allow you more time to focus on practicing medicine. However, they often task all the hard work back to you. Look for a billing service like ours, which provides the expertise and specialized advocates that will take on chal- lenging tasks for you, like credentialing and denial resolu- tion. As a billing partner, NextGen Healthcare proactively drives revenue and prepares you for future change by finding medical billing problems and taking care of them before they ever come to you. In addition, we analyze your unpaid and underpaid claims and aggressively follow up with insurance companies. Continuously monitoring the ageing buckets of your A/R, we keep in touch with insurance companies to ensure that claims are settled as quickly as possible.
  14. 14. Partner with RCM experts who will continuously drive results. 6
  15. 15. Do your financial results suffer because there’s not enough bandwidth to effectively handle everything? Good talent is hard to find. Without the right IT systems and expertise, you can lose patient care time as you struggle to better manage costly revenue cycle issues like denials and claim errors. To achieve the best results possible, find a provider with a consultative approach to billing. One that brings RCM and technology experts together to provide the intelligence needed to drive results. Our experts meet regularly with clients and their staff, ensuring they understand revenue cycle performance metrics, performance drivers, and any trends that may help them respond to marketplace changes. You get the expertise and strategic input to turn information into actionable business insights. The NextGen RCM Services account manager drives process improvements, system enhancements, and best practices while acting as your financial analyst. They are experts at using practice management software and healthcare information technology to ensure your practice is using them to their fullest potential. They continuously monitor your key performance indicators — such as your top denials — providing detailed reports as well as action plans to help you optimize reimbursements while reducing denials and days in A/R. The NextGen RCM Services account manager drives process improvements, system enhancements, and best practices while acting as your financial analyst. “Data is everything to us. NextGen gives us situational awareness so we can imple- ment improvements. It all works because we have the right team internally and externally with NextGen. ”Debbie Redd, CEO/President Capital Women’s Care
  16. 16. Pick a flexible, value-based service provider who won’t drain your wallet. 7
  17. 17. Are you getting every penny you deserve? Today, keeping pace means not only driving better patient outcomes, but also running a healthy business. Billing used to be simpler and price was the driver in choosing a vendor. Today, the standard focuses on value, results, and meeting ever-changing billing requirements. Make sure you fully understand a given partner’s ROI potential. Too often, when outsourcing billing, the promise of reduced overhead costs does not pan out and the practice ends up disappointed. Flexible value-based purchasing options offer a pricing model that is not fixed and is aligned with a practice’s revenue cycle results. Top practices choose NextGen RCM Services because of our pay for performance ACO-type model, where we get paid when you get paid. NextGen RCM Services also offers flexible value-based payment models and supports alternative payment models—such as those that may require HCC coding or population health applications. When choosing a provider, beware of emerging ACO payment options that have recurring standard fees that can be quite high. Minimize your risks and make sure you fully evaluate and negotiate terms and don’t overlook any recurring standard minimal fees that other vendors may apply.
  18. 18. ” “ A year after our RCM transition, our billing department team better values their roles and is more knowledgeable about all aspects of the billing process. There’s more cross-coverage, PTO flexibility, and time for special projects. We’ve stopped drowning in our holding tank. Sarah Ortiz, Revenue Cycle Manager CommUnityCare
  19. 19. Financially Thrive. Reduce or eliminate administrative headaches. Ensure your ongoing readiness for healthcare change. Tap into NextGen RCM Services to empower your ongoing success.
  20. 20. Copyright © 2014 NextGen Healthcare Information Systems, LLC. All rights reserved. NextGen is a registered trademark of QSI Management, LLC, an affiliate of NextGen Healthcare Information Systems, LLC. All other names and marks are the property of their respective owners. Patent pending. NextGen® Ambulatory EHR version 5.8 is ONC Certified HIT 2014 Edition certified as a complete EHR. For full certification details, please visit www.cchit.org NextGen Healthcare Information Systems, LLC 795 Horsham Road, Horsham, PA 19044 p: 215.657.7010 | f: 215.657.7011 insidesales@nextgen.com | nextgen.com EDU28-5/14 Take the Next Step Contact us to find out how we can help you. Call us toll free at: 314.989.0300 or visit nextgen.com/RCM