Survey examines revenue cycle management for medical practices

Medical practices usually do not outsource their billing and collections processes, but revenue cycle management is becoming more popular, according to a recent survey of several hundred practices. NextGen Healthcare conducted the survey and included clients and non-clients.

More than 75 percent of the practices said they did not outsource their billing, while 11 percent said they outsourced all of their billing. The practices said their billing professionals could post 137 payments and adjustments per day on average.

The most common aspects of the revenue cycle management systems that practices automated were claim scrubbing (65 percent of practices), tasking staff with accounts receivables and denial follow-ups (55 percent), automatic appointment reminders (47 percent), coding assistance (45 percent), automated eligibility-inquiry checks (44 percent) and automated reporting (27 percent).

On a scale of 1 to 10 with 10 being “excellent,” 49 percent of practices said their electronic submission billing capabilities were between 7 and 9, 4 percent said their capabilities were a 10 and 22 percent said their abilities were between 1 and 5.

In addition, 21 percent of practices said they were “very confident” in their ICD-10 preparation, 50 percent said they were “somewhat confident” and 23 percent said they were “not at all confident.”

Practices from more than 40 states participated in the survey. The practices ranged from 1 to 100 doctors, and 65 percent of practices had between 1 and 10 providers.

Twelve percent of the respondents’ practices were hospital-owned. The most common specialties were ophthalmology (16 percent of respondents), primary care/internal medicine/family medicine (10 percent), obstetrics and gynecology (4 percent), cardiology (4 percent) and pediatrics (3 percent).

NextGen recommends that practices measure their billing and collections performance and compare them each month. The company suggests practices should aim for a net collection percentage of 90 to 95 percent, a clean claim rate of 90 percent or higher, a percentage of outstanding colections for dates of service older than 120 days of 10 to 15 percent and days in accounts receivables of 30 days or less.

Read the survey results here.

Tim Casey,

Executive Editor

Tim Casey joined TriMed Media Group in 2015 as Executive Editor. For the previous four years, he worked as an editor and writer for HMP Communications, primarily focused on covering managed care issues and reporting from medical and health care conferences. He was also a staff reporter at the Sacramento Bee for more than four years covering professional, college and high school sports. He earned his undergraduate degree in psychology from the University of Notre Dame and his MBA degree from Georgetown University.

Around the web

The tirzepatide shortage that first began in 2022 has been resolved. Drug companies distributing compounded versions of the popular drug now have two to three more months to distribute their remaining supply.

The 24 members of the House Task Force on AI—12 reps from each party—have posted a 253-page report detailing their bipartisan vision for encouraging innovation while minimizing risks. 

Merck sent Hansoh Pharma, a Chinese biopharmaceutical company, an upfront payment of $112 million to license a new investigational GLP-1 receptor agonist. There could be many more payments to come if certain milestones are met.