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Why Investing in Revenue Cycle Management Services is On the Rise

outsourcing revenue cycle management
Revenue cycle management is not something that most medical professionals understand, but it is a concept that is very near and dear to the bottom line of each medical practice. These days, medical practice management is being split up into two segments: managing the daily operations of the office and managing the way the practice does business. These are two separate functions and they both require full-time attention, which is why RCM outsourcing is on the rise.

What Is RCM?

The concept of real RCM goes well beyond simple medical practice billing. Real RCM manages the practice's interactions with every insurance company, develops billing procedures for uninsured patients, helps qualify new patients, and keeps an eye on any changes that would affect medical billing revenue. As the medical world and its insurance requirements get more complex, outsourcing RCM functions becomes more necessary, even for the smallest medical practice.

What Does An RCM Company Manage?

professional RCM firm can manage the interactions between the medical practice and insurance companies, other medical practices, and uninsured patients. An RCM company stays up to date on any changes in the requirements of each insurance company a medical practice works with and then helps the practice alter its business process to accommodate these types of changes. An RCM firm can also make suggestions on ways to improve efficiency and get more out of the billing process.

Why Would A Medical Practice Invest In RCM Services?

When a medical practice thinks of all of the money it loses each year by performing procedures that are not covered by insurance, then it becomes easy to see why RCM is so important. A medical practice that does not keep up with changes in insurance law and health insurance procedure will find itself way behind on its billing processes and suffering from a lack of revenue. 

Outsourcing revenue cycle management results in multiple benefits, including smoothing out the business side of a medical practice and ensuring that the revenue is always being handled properly. RCM professionals can put processes in place that make it possible for a medical practice to know right away if a procedure is covered under a particular insurance carrier and the steps required to ensure the practice can get reimbursed as quickly as possible. In addition, RCM firms can provide assistance with the creation of internal systems that can increase efficiency and also result in increased profits.

The Beckers Hospital Review points out that a study showed that many CIOs of medical practices said that their practices faced bankruptcy without the help of RCM professionals. 

The situation may not be that grave for every medical practice, but the fact is that investing in RCM services makes a medical practice more profitable and financially resilient to face future challenges. Another benefit to utilizing RCM services is that it allows the medical practice to keep its focus on offering the best possible medical services, which is why medical professionals get into the business of helping people in the first place.

For over 20 years, GroupOne Health Source has offered full-service medical billing, transcription, technology, and consulting for a diverse range of clients throughout the US. Our expertise in all aspects of revenue cycle management makes us uniquely suited to help medical practices gain a competitive edge. Contact us at for more information.

George N Root III is a professional freelance writer who has expertise in topics such as Internet marketing, business, advertising, and personal finance.

Senate Passes Bill Stabilizing Doctors' Payments and Ending SGR Formula

end of SGR formula

The Sustainable Growth Rate (SGR) formula has been eliminated. The Senate voted 92-8 to pass the Medicare Access and CHIP Reauthorization Act of 2015, which will replace the Sustainable Growth Rate. It was passed on the eve of a 21 percent cut to physicians' Medicare payments which was set to take place. Instead, the new legislation removes much of the instability and uncertainty that long has plagued the Medicare payment system so practices can focus on patient care. A huge step in the right direction, the bill also includes several other important improvements for physician practices. 

CMS Proposed Rule to Shorten Meaningful Use Reporting Period


CMS issued a new proposed rule for the Medicare and Medicaid EHR Incentive Programs  to align Stage 1 and Stage 2 objectives and measures with the long-term proposals for Stage 3.

eClinicalWorks and Epic Live with Interoperability between Systems Using Carequality Framework

eClinicalWorks and epic

CHICAGO--(BUSINESS WIRE)--eClinicalWorks® and Epic, two of the most widely used electronic health record systems (EHR) in the U.S., today jointly announce interoperability between the companies’ EHR systems using the Carequality framework. This real-time data transfer between the systems facilitates coordination of care between providers in various care settings and ensures they have more complete and accurate patient information at the time of care. Together, the two companies’ patient record exchange networks represent over 1,000 hospitals and 40,000 clinics that are ready to connect.

Update on the Status of Provisions Expiring on April 1


The negative 21% payment rate adjustment under current law for the Medicare Physician FeeSchedule is scheduled to take effect on April 1, 2015.  CMS is taking steps to limit the impact on Medicare providers and beneficiaries by holding claims for a short period of time beginning on April 1st.  Holding claims for a short period of time allows CMS to implement any subsequent Congressional action while minimizing claims reprocessing and disruption of physician cash flow in the event of legislation addressing the 21% payment reduction.  Under current law, electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt. CMS will provide more information about next steps by April 11, 2015.

2013 Quality and Resource Use Reports Are Available Online


Did you know that CMS provided Quality and Resource Use Reports (QRURs) to  physicians in groups of all sizes and physician solo practitioners in September of 2014? The 2013 QRURs provide clinically meaningful and actionable information that can be used to improve the quality and efficiency of care provided to Medicare beneficiaries and also to understand and improve performance on quality and cost measures. If you are a physician subject to the Value-Based Payment Modifier (VM) Program, the reports also contain information about how your performance is affecting your Medicare payments in 2015.


H.R. 2 Reauthorization Act of 2015 to Replace SGR Formula

H.R. 2

By a vote of 392 – 37, the House of Representatives passed H.R. 2, the Medicare Access  and CHIP (Children's Health Insurance Program) Reauthorization Act of 2015, which, among other things, would permanently repeal and replace the SGR formula. 

NPRM for Stage 3 Meaningful Use & 2015 Edition Certification Criteria

CMS Stage 3 Requirements

On Friday, CMS released a notice of proposed rulemaking (NPRM) for Stage 3, the next step in the implementation of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. Concurrently, ONC also announced the proposed 2015 Edition certification criteria for health IT products. Both proposed rules focus on the interoperability of data across systems, and make the EHR Incentive Programs simpler and more flexible.

CMS Announces Extension for EPs Participating in PQRS via EHR and QCDR (QRDA III format)

eHealth PQRS extension deadline
The Centers for Medicare & Medicaid Services (CMS) announced that the submission deadlines for the PQRS reporting methods below have been extended. All other submission timeframes for other PQRS reporting methods remain the same.

The revised submission deadline is March 20, 2015 at 8 pm ET for the following reporting methods:

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CMS Extends EHR Attestation Deadline for Medicare Eligible Professionals


Eligible professionals now have until 11:59 pm ET on March 20, 2015to attest to meaningful use for the Medicare Electronic Health Record (EHR) Incentive Program 2014 reporting year. 

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