It’s happened to countless private practices: One day, you realize that your revenue numbers aren’t sustainable. Your accounts receivable (A/R) is astronomical. Your claim denial rate has stretched into the double digits. Your cash flow is abysmal.
So, you dig into what’s happening with your insurance billing and revenue cycle. If an in-house team member manages the billing (that includes you!), you may find that they’re swamped and burnt out from the massive amount of administrative work. If it’s an outsourced biller, it may be time to have a tough — but essential — conversation about righting the ship.
When you decide it’s time to take a different tack with your billing, you’ll need to find a new medical billing and revenue cycle management (RCM) partner. Ideally, that billing/RCM solution will integrate with your existing electronic health record (EHR) and practice workflow.
Before diving into a new billing relationship, here’s what you can expect during integration and the stages of EHR and RCM implementation.
What Happens When I Want to Change Billers?
Once you decide to implement a new billing approach, remember that you’ll have to transition out of your previous billing process. If you have an in-house billing team, that may mean adding some new software to the mix. Or, you may consider changing your internal processes and adding a supplemental (outsourced) team who can offload some of the administrative work.
However, if you’re primarily using an outsourced biller, it may be time to cut ties with that group. At first, they may have an explanation for the underperformance. They may even put new or additional staff on your account to move your numbers in the right direction.
Unfortunately, these billers often go back to their old ways. Once your account seems stable, they’ll shift the top-performing team to a new client. And within six months, your practice is underperforming again.
Ultimately, you’re better off finding a new billing and RCM vendor who can identify your reimbursement problems and offer real solutions from the beginning. It’s also critical that this vendor has documented RCM expertise and certified professional coders who can ensure accuracy with your claim process.
Will I See Immediate Revenue Growth When I Switch Outsourced Billers?
If you currently use an outsourced biller and decide to switch billers, remember that your billing contract likely has a “notice” period and a “work down” period.
- The notice period is the number of days you need to provide your biller before they stop submitting new claims.
- The work down period is the number of days they have to work claims they have already submitted.
Each of these periods is usually 30-60 days. Your new biller will only take on new claims after the notice period.
Because of this transition, your practice won’t see revenue growth with the new biller immediately. Your revenue will likely stay flat for the first three months or so.
Revenue Responsibility
At the beginning of your new billing/RCM relationship, the old and new billers will share responsibility for your practice’s revenue. Even if your new biller is performing well, the underperforming old biller still affects your cash flow.
When a new customer onboards with Gentem’s billing and RCM, we typically see this kind of revenue split:
- Month one with Gentem: Old biller is responsible for 80% of the practice’s revenue, Gentem 20%
- Month two with Gentem: Old biller 50%, Gentem 50%
- Month three with Gentem: Old biller 20%, Gentem 80%
- Month four with Gentem: Gentem is responsible for nearly 100% of revenue
Implementing Your New RCM Tool with Your EHR
Now that you have an idea of the transition between an old and new RCM, let’s talk about the stages of EHR and RCM implementation.
Provide Documentation to Your Implementation Team
Before your new billing/RCM partner can start billing claims, your practice must provide documentation to the vendor’s implementation team. This documentation will give the billing/RCM partner the information they need to accurately and efficiently file claims on behalf of your practice. It’s important to provide this documentation promptly to help keep the stages of EHR and RCM implementation on track.
Some examples of documentation you may need to provide:
- Insurance fee schedules
- Payer contracts
- Payer list
- Practice and provider NPIs
- Practice tax ID
- Self-pay fee schedules
If your practice also needs credentialing before the new RCM starts filling claims, you may also need to provide:
- Board certificates,
- IRS documentation
- Logins for the Council on Affordable Quality Healthcare (CAQH) database
Get Necessary Credentials and Enrollments
Once you’ve provided all the documentation to your implementation team, they’ll work on credentialing (if needed) as well as electronic data interchange (EDI) and electronic remittance advice (ERA) enrollments. These enrollments will allow your practice to file claims with payers electronically.
When you work with Gentem, our implementation team partners with you throughout this entire process. If any issues or questions arise, we will stay in touch and collaborate with you on the answers.
EHR and RCM Integration
After your RCM implementation team completes credentialing and enrollments, it’s time to integrate your new RCM with your practice’s EHR. With this process, your practice will create the appointment in the EHR, sign the encounter notes and set the claim status. Then, your RCM will import this data into its system to submit and work the claim.
Here’s a glimpse into what the EHR and RCM integration process looks like at Gentem.
Pull Data From the EHR
When you kick off an EHR integration with Gentem, we’ll start the process by pulling appointment, patient and charge reports from your EHR. The specifics of this process will depend on which EHR you have, but our team will handle pulling the data that you’ve entered into your EHR.
Align Statuses Between the EHR and RCM
After we confirm that we can pull data from your EHR, our team ensures the information fields and claim statuses in your EHR align with our software. For example, your EHR may have an appointment status of “booked,” which would align with the “scheduled” status in our platform.
During this process, we typically schedule a couple of short (30-minute) working sessions with your team to identify all the fields and statuses. We’ll ensure our teams are on the same page so the claim process will be seamless when we officially launch.
Validate and Test Data
Before we start billing claims for your practice, our team will double-check the data we’re pulling from your EHR and ensure we’re uploading it correctly to our platform. We typically test a small set of data from your EHR to verify the workflow is correct. This pre-launch data validation sets us up for a successful and seamless launch, so you can avoid any hiccups in your reimbursement process.
Launch Integration
Once we launch your practice with our fully-managed RCM system, our team will pull charges from your EHR every evening and import them into our platform to file the claims. We also pull patient/appointment data every week to verify insurance before the patient encounter.
After your practice is up and running with the Gentem platform, our team of certified professional coders (CPCs) will review and verify every claim to ensure you’re maximizing reimbursements and avoiding costly rejections and denials.
How Long Does Implementing a New EHR and RCM Process Take?
This is a common question we hear from new clients, and it’s challenging to answer. Truthfully, the implementation process can vary quite a bit. If your practice needs credentialing, insurance companies will dictate the timing.
However, integrating a new RCM system with your EHR often doesn’t take long. At Gentem, we work with some of the most common private practice EHRs and have streamlined this process. After a few short working sessions, we typically have the system set up and ready to go.
