Is Your AR "Streaming"?

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If you’re like most healthcare providers, you have a nagging concern: is my billing service giving me the bandwidth I need to be successful? In other words, does your billing service proactively work with you and your team to understand your business and then give you the resources needed in order to keep your AR moving and get it collected? Or are you just fitting in to their profit-taking formula? Billing services are famous for controlling their own costs after landing new clients, focusing on the easy billing in order to keep their profit margins high. Unless you are consistently driving your billing service to excellence on behalf of your business, they are only working for their own profit. Because of this, many healthcare providers have left money on the table, and they have no idea why, how, or how much. RPM Billing was created to be the answer to all of the overpriced and underperforming billing services out there.

In our experience, our clients’ previous billing services leave between 20-50% of the potential revenue on the table. It’s shameful.
— Jonathan Marshall, MBA, President of RPM Billing

In healthcare, AR either moves or stays still. Think of a valley full of streams and ponds of water. The water in the streams is moving and in the ponds it stays still. Now think of a healthcare AR system, in which the accounts are the “water”. A healthy AR system has “streams” of accounts moving towards payment. A broken AR system has “ponds” of aging accounts that aren’t being worked and are not moving towards payment, instead they just age on your AR reports and become less likely to collect. A good billing service should be working all accounts and claims in the AR at regular intervals, so that they keep moving, like a stream, towards payment.

The ideal “streaming” of the AR starts with a timely claim sent to the correct insurance company, then involves verification that the claim was received and is being processed, then confirmation from the insurance company that the claim is being paid, and lastly the payment arrives. There are numerous opportunities for a claim to be diverted to different “streams”, such as denials. All of the “streams and ponds” in healthcare AR must all be worked, all the time.

The old adage applies: “When you’re up to your neck in alligators, it’s easy to forget that your mission is to drain the swamp.” In healthcare AR management, it’s easy to focus on the repeated task of draining the ponds where it gets stuck. However, the real work must be done at the source of each pond. The billing service should work in a positive and proactive fashion to understand the source of each denial and delay in payment, and continually share that information with other areas of the business so that the root causes can be fixed. Better management of the processes results in better “streams” of AR, to keep them moving towards payment so that there are fewer “ponding” issues to worry about. The more process issues you have in your operations, the more “ponds” you will have in your AR, and the higher your over-90 day AR becomes, which means more delays instead of payments, so you end up with a lower paying AR and more billing resources required to work it all.

This is where it gets easy for most billing services: just keep costs low and ignore the hard stuff. Its a simple profit-taking formula. Most claims get paid timely and it requires very little human interaction with today’s technology. This means billing services make most of their revenue with very little cost. Conversely, it also means that most of the billing company’s cost can be chewed up in the inefficient lower-paying "ponding" accounts. So most of them simply cut that cost out and skip that work. With vague reporting, they have little accountability for actual results, and so there is little motivation for them to commit the extra resources to get their clients to 100% of payments they are due. In fact, doing that extra work is actually an incremental financial loss for the billing company, and they aren’t interested in that. In our experience, our clients’ previous billing services leave between 20-50% of the potential revenue on the table. It’s shameful. As for the claims that don’t get paid, the clients almost never really know what’s missing, or which questions to ask, so the mistakes are easily hidden. The aging “ponds” of AR are only occasionally worked (typically with much fanfare), and the source of the issues are rarely actually fixed (also with fanfare of course). Healthcare providers deserve better, and that is why RPM Billing was created.

RPM Billing is a medical billing and consulting firm based in Las Vegas and Reno, Nevada, serving doctors, hospitals, and other healthcare providers nationwide. We have an experienced billing team, and we work closely with our clients to make sure 100% of their bills get paid appropriately and timely. Led by Jonathan Marshall, who holds a Healthcare MBA and two decades of experience as CEO, CFO, and COO of hospitals and physician practices, RPM Billing was created as the answer to all of the overpriced and underperforming billing offices out there. We are 100% committed to excellent service, processes, bottom line results, and ethics. To contact us for a free review of your company’s opportunities to improve revenues, please call us at 775-501-9820, email us at jon@rpmbilling.com, or visit us at www.rpmbilling.com. Thank you.