In this episode of “Med Practice Made Perfect”, host Tom Maher dissects the insourcing-versus-outsourcing dilemma in revenue cycle management (RCM) for medical practices. Maher explores the contrasting viewpoints on control, oversight, and cost-effectiveness associated with each approach. If you’re debating whether to keep your healthcare billing and coding internal or outsource it with an RCM vendor, this is a great place to start.

Tom introduces the industry debate by outlining the opposing perspectives on insourcing and outsourcing RCM services. Insourcing offers control and oversight, while outsourcing provides relief from administrative burdens and access to specialized expertise. There are challenges inherent in RCM, such as staying updated on regulations and managing talent shortages. However, he also underscores the opportunities presented by both insourcing and outsourcing, including scalability and access to advanced technologies.

There are major financial considerations involved in insourcing versus outsourcing RCM services. While insourcing may initially seem financially advantageous, hidden costs like employee turnover can impact the bottom line. Conversely, outsourcing costs vary based on fee structures and service quality. Selecting the right outsourcing partner is crucial. Trusted referrals and clear contractual agreements are essential.

Understanding your RCM partner's expertise and technological capabilities is paramount for long-term success because effective RCM requires insightful analysis. Data analytics enable practices to identify trends and optimize revenue streams. From monitoring insurance distribution to tracking referral patterns, data-driven insights empower informed decision-making.

It’s critically important to align with RCM partners who share your practice's vision. Whether opting for insourcing or outsourcing RCM services, practices must weigh the advantages, challenges, and costs. By leveraging expertise and technology, practices can navigate the complexities of revenue cycle management and drive growth in healthcare management.

Practicefirst is an industry leader in revenue cycle management, providing medical billing, coding, credentialing, and full-service practice management solutions to healthcare organizations.

Welcome to MedPractice Made Perfect, brought to you by Practicefirst Medical Management Solutions. In this episode, host Tom Maher will delve into a pressing issue affecting many medical practices: termination letters for RCM services from Optum.

Understanding the Situation

Optum recently acquired a significant portion of business from ChangeHealthcare. As part of the integration process, Optum has begun terminating contracts with practices having fewer than 16 providers. These termination notices typically provide a 90-day window for practices to find alternative solutions.

Considering Insourcing vs. Outsourcing

Some practices may consider insourcing their revenue cycle management (RCM) processes as an alternative to outsourcing. However, there are crucial factors to consider. Assessing the size of your practice and the availability of qualified staff is essential. In today's market, there's a shortage of experienced billers, making it challenging to maintain an in-house RCM team, especially for smaller practices.

Transitioning to New Platforms

Many affected practices are using the Medent platform, tied to Optum's license. Transitioning to a new Medent license, particularly the cloud-based option, may be necessary. While this transition might come with additional costs, it offers advantages such as enhanced security, centralized claims processing, and access to advanced tools.

Other Considerations

It's important to note that Optum is not the only entity divesting smaller clients. Other providers may face similar situations in the future. For practices seeking support during this transition, companies like Practicefirst offer comprehensive RCM solutions backed by decades of experience.

Support from Practicefirst

Practicefirst, with 64 years of service in the New York area and a presence in multiple states, specializes in billing, coding, and credentialing across various specialties and carriers. While we have a minimum fee for billing services, we cater to practices of varying sizes and offer flexible solutions tailored to individual needs.

Conclusion

If you find yourself grappling with an Optum termination letter for RCM services or similar challenges, don't hesitate to reach out to Practicefirst. We can provide guidance and support to ensure a smooth transition and uninterrupted revenue flow for your practice.

Practicefirst is an industry leader in revenue cycle management, providing medical billing, coding, credentialing, and full-service practice management solutions to healthcare organizations.

Starting a medical practice is a process rife with potential landmines. If caught off guard, hopeful practice owners may find themselves dealing with major delays, incurring fines, or experiencing significant revenue cycle issues down the road. 

In this insightful podcast episode, we delve into some of the key intricacies of launching a successful medical practice while giving a broad overview of the process. Host Tom Maher shares his valuable insights on the logistical planning, legal considerations, and financial aspects involved in starting a medical practice. From navigating regulatory hurdles to building a strong foundation for patient communications, this episode offers a helpful guide for aspiring medical practitioners looking to embark on their entrepreneurial journey.

Tom addresses key topics such as choosing and setting up a business entity, establishing effective patient communication strategies, and operational considerations such as office space and the hiring process. Whether you're a recent medical graduate or an experienced practitioner contemplating the shift to private practice, this podcast serves as an invaluable resource, offering actionable tips to empower healthcare professionals in realizing their goal of launching a thriving medical practice while avoiding common mistakes.

For more content like this, subscribe to Med Practice Made Perfect on YouTube, Spotify, Apple, or Google Podcasts.

About Tom Maher

As President and CEO of a growing organization in a complex industry, Tom Maher focuses on people: Practicefirst employees and clients. “You can’t have one without the other, and Practicefirst is successful because we take care of both.” He oversees a diverse and talented team of experienced professionals; whose collective mission is to maximize the value of their clients’ medical practices, so they can focus on the health and well-being of their patients.

Follow Tom on LinkedIn - https://www.linkedin.com/in/tom-maher-090569a/

Practicefirst is an industry leader in revenue cycle management, providing medical billing, coding, credentialing, and full-service practice management solutions to healthcare organizations.

The online presence of healthcare practices presents distinct challenges that administrators must navigate, setting it apart from other industries. In this insightful episode, Tom’s guest Claire Carlo highlights the significance of establishing a strong foundation for effective healthcare marketing. Key elements, such as a mobile-optimized website and readily accessible transactional details like contact information and appointment scheduling, are fundamental to success. However, Claire stresses that these foundational components must not stand alone. For example, healthcare websites must be optimized for search engines and mobile devices to ensure their efforts bear fruit. 

Claire delves into strategies for managing a healthcare practice's reputation and addresses the complexities of handling both positive and negative reviews across various social media platforms. These insights provide valuable guidance on maintaining a positive online image, a critical aspect in today's digital landscape. Claire's insights offer a holistic approach to maintaining a positive and influential online image for healthcare practices in an ever-evolving marketing world.

For more content like this, subscribe to Med Practice Made Perfect on YouTube, Spotify, Apple, or Google Podcasts.

About Tom Maher

As President and CEO of a growing organization in a complex industry, Tom Maher focuses on people: Practicefirst employees and clients. “You can’t have one without the other, and Practicefirst is successful because we take care of both.” He oversees a diverse and talented team of experienced professionals; whose collective mission is to maximize the value of their clients’ medical practices, so they can focus on the health and well-being of their patients.

Follow Tom on LinkedIn - https://www.linkedin.com/in/tom-maher-090569a/

About Claire Carlo

Claire Carlo, MBA, is President at The Reds Group. Claire's experience includes senior leadership positions in strategic marketing and communication for healthcare and educational institutions throughout the United States; being a partner in an entrepreneurial physician management firm with multiple service lines; and helping to position and launch a robust commercial real estate development firm.

An experienced leader, manager, educator and public speaker, Claire has earned numerous awards for the work of her teams. She believes in the importance and power of words, she has an artful eye and she likes to work with creative and kind people.

Follow Claire on LinkedIn - https://www.linkedin.com/in/claire-carlo-82460a21/

Practicefirst is an industry leader in revenue cycle management, providing medical billing, coding, credentialing, and full-service practice management solutions to healthcare organizations.

In this episode of the MedPractice MadePerfect podcast, host Tom Maher reviews a selection of important policy changes stemming from the end of the COVID-19 Public Health Emergency (PHE). 

Practicefirst is an industry leader in revenue cycle management, providing medical billing, coding, credentialing, and full-service practice management solutions to healthcare organizations.

While coding algorithms can significantly improve the accuracy and efficiency of medical coding, they are not a replacement for human expertise. In fact, working with coders is essential to optimizing the use of coding algorithms and maximizing profitability.

Coders play a critical role in ensuring that coding algorithms are used correctly and effectively. They are trained to identify nuances and complexities in medical data that algorithms may miss, ensuring that codes accurately reflect a patient's condition, treatment, and procedures. Additionally, coders provide a level of quality control, ensuring that codes are consistent, compliant with regulations, and optimized for reimbursement rates.

By working with coders in addition to algorithms, medical practices can achieve significant benefits. Improved accuracy in coding leads to more accurate billing and fewer claim denials, which can positively impact the financial health of the practice. Additionally, accurate coding ensures that patients receive appropriate care and treatment, which can lead to better health outcomes and higher patient satisfaction.

In this episode of the Med Practice Mad Perfect podcast, Tom’s guests are Practicefirst’s coding managers Kelly Cole (CPC, CMBS, CPMA) and Vidya Baliga (COC, CPMA, CRC) both of whom are certified coders and certified auditors through AAPC. They discuss the challenges and opportunities that arise from the use of coding algorithms, as well as best practices for ensuring that coders are trained and supported to use algorithms effectively.

Listen to learn more about how medical practices greatly benefit from working with coders in addition to algorithms to maximize accuracy and therefore profitability.

Practicefirst is an industry leader in revenue cycle management, providing medical billing, coding, credentialing, and full-service practice management solutions to healthcare organizations.

Key Performance Indicators (KPIs) are essential metrics used by successful medical practices to monitor their financial health and boost profitability. By establishing KPIs, practices can track important numbers such as revenue, expenses, and cash flow trends. KPIs help identify potential issues in the revenue cycle before they become major problems for the practice's finances.

KPIs should be tracked regularly, at least yearly, but ideally even more frequently such as month-over-month, to ensure that the practice is on the right track. These metrics can also be compared against national averages and other practices in the area to determine how the practice is performing compared to its competition.

In this episode of Med Practice Made Perfect, host Tom Maher explains how to calculate and track some of the most important KPIs for medical practices, including the average charge per encounter, average receipt per encounter, and collection ratio. By regularly monitoring these metrics, medical practices can stay on top of their financial health and make adjustments to improve their profitability.

To learn more, listen and subscribe to Med Practice Made Perfect.

Practicefirst is an industry leader in revenue cycle management, providing medical billing, coding, credentialing, and full-service practice management solutions to healthcare organizations.

Not everyone thinks of a medical practice as a business - but in fact, it is just that, a business - and people want to be treated the right way. That includes interactions with their doctor and any healthcare provider, but also the rest of the staff.

It is very important that your patients feel empathy from your team for their medical plight but also cared for as a customer. It is important to ensure a great experience by finding the right combination of personalities and procedures to manage funds due from patients so that your medical practice can flourish, survive, and continue to be available when they need you.

High-deductible medical insurance plans have created the need for significant changes in billing processes, beginning with managing client expectations before they walk through your door. In our second episode of Med Practice Made Perfect, Tom Maher shares actionable advice to help improve your revenue cycle by creating a sound payment policy, communicating that policy to your patients, and collecting payments in a timely manner.

Listen and subscribe to our YouTube channel to learn more!

Practicefirst is an industry leader in revenue cycle management, providing medical billing, coding, credentialing, and full-service practice management solutions to healthcare organizations.

Medical practices have long been faced with adapting to the rapidly-changing insurance landscape, including major shifts in policy like the Medicare Prescription Drug Improvement and Modernization Act of 2003, and the Affordable Care Act in 2010. The latter introduced high deductible plans to the American public; a major departure from the payment arrangement that both practices and customers had been accustomed to.
 

Your practice's billing and coding procedures may have kept up with policy changes from a compliance standpoint, but have your daily operations readjusted to serve today's patients who now must manage an increase in their individual financial responsibility?
If not, you're likely losing patients - or, in other words, customers - and dramatically slowing your revenue cycle as a result.

This episode of Med Practice Made Perfect will share best practices for managing patient expectations, receiving funds for services rendered, and avoiding costly collections processes - all as the result of simple and actionable operational improvements.

Our host is Tom Maher, President, and CEO. As President and CEO of a growing organization in a complex industry, Thomas Maher focuses on people: Practicefirst employees and clients. “You can’t have one without the other, and Practicefirst is successful because we take care of both.” He oversees a diverse and talented team of experienced professionals; whose collective mission is to maximize the value of their client’s medical practices, so they can focus on the health and well-being of their patients.

Subscribe to Med Practice Made Perfect for more insightful content tailored specifically for practice partners and managers: 

Practicefirst is an industry leader in revenue cycle management, providing medical billing, coding, credentialing, and full-service practice management solutions to healthcare organizations.