Supporting Top RCM challenges in independent Orthopedic groups

Independent orthopedic practices and their owners continue to face a litany of challenges and pain points with operating their practices. Near the top of almost every practice manager’s or surgeon’s pain points is overall revenue cycle management (RCM) and ensuring the practice remains profitable. From our experience, there are four key areas that all practices must consider:

1.      Orthopedic specific expertise is key to success, particularly in two main areas:

Coding, understanding the nuances of complicated orthopedic procedures is a must have but also staying current on cutting edge procedures takes a deep knowledge of the orthopedic specialty. Ensuring the right levels are being coded and your practice is leveraging the most up to date processes (i.e. Principal Care Management – PCM) are key to ensuring reimbursement is being maximized for the work being done.

Authorizations, decreasing denials is one of the fastest ways practices can ensure that the services they perform will be reimbursed. Ensuring documentation is done timely and correctly can help reduce not only denials, but also increase patient experience while avoiding last minute delays and/or cancellations while waiting for authorizations.

2.      Understanding the ever-changing payer dynamics and protocols:

National payers continue to change the rules from potential down coding of claims to an overall lack of transparency in processes. Having the expertise to understand trends by payer while also the expertise to quickly adapt to those trends is not something that should be optional.

Local payers also have their own uniqueness that often times national revenue cycle companies fail to understand. Ensuring local payer knowledge is retained and leveraged is key to maximizing reimbursement across all payers.

3.      Transparency in operations:

Having visibility into the metrics that matter for practices is vital, practices have little to know insight into key items like Net Collections Ratio (NCR), denial rates, outstanding accounts receivable (A/R), charge entry lag and other operational metrics.

Partnering with a company who is EMR/PM agnostic and can quickly elevate and not just report the data but bring insight to drive decision making is key. Leveraging the data to understand trends at both the provider level but also payer level is essential to support real time process change.

4.      A trusted partner at your side:

Having a partner with a vested interest in your success is essential. A team that wakes up every day reviewing trends in performance metrics, analyzing denials and building process changes, a team that is available for ongoing cadence of calls/meetings to provide transparency into performance and lastly a team who succeeds when your practice is successful is a non-negotiable.