Operating a healthcare practice in New York State entails a one-of-a-kind set of challenges—from navigating complex insurance systems to maintaining compliance with regulations that are always changing. In an ever-changing environment like healthcare, it is equally important to manage your practice’s financial health as it is to provide exemplary patient care. Revenue Cycle Management (RCM) plays an important role in that process.

 

New York healthcare providers in all boroughs—Manhattan, Brooklyn, Queens, the Bronx, or Staten Island—can unlock concealed revenue and improve cash flow with A/R Recovery and Claims Resolution Support services—all of which are essential RCM components to assure you are compensated in full and in a timely manner for the care you provide.

 

What is RCM?

Revenue Cycle Management is the full financial bottom line of patient care, from scheduling and insurance verification to billing and collection, and receiving the final payment. In a city like New York where costs for running a healthcare business are the highest, one dollar is just as important as a hundred dollars. An effective RCM process will make sure that claims were submitted correctly, payments are received timely, and the number of denials is minimized.

RCM includes:

• Patient registration and insurance verification
• Medical coding and charge capture
• Claims submission
• Denials management
• A/R follow-up
• Collecting and reporting

Every process must be streamlined to reduce revenue loss and comply with local, state and federal laws.

Why do New York Providers Need A/R Recovery?

Accounts Receivable (A/R) can be explained as claims or balances due from patients or insurers. Ageing A/R threatens consistent cash flow for many New York practices. Claims can get lost in the chaos of high patient traffic and complex payer networks.

Services offered by reputable A/R recovery includes:

•  Review of outstanding balances
•  Prioritization of claims based on amount owed and age
•  Identifying and addressing issues causing non-payment
•  Contacting payers and/or patients to collect outstanding balances
•  Correcting and resubmitting claims where necessary

 By outsourcing their A/R recovery to specialists familiar with New York payors and billing rules and regulations, they can expect to recover revenue faster, and minimize write-offs.

Resolutions for Claims Denials with Claims Resolution SupportClaim denials are almost commonplace in New York due to the fact that Medicaid, Medicare, and private insurers all have varying rules. Each denied claim is a lost opportunity, provided it is dealt with quickly and in the proper way.

Claim resolution support emphasizes the following:

Reviewing the denial reasons

Correcting documentation or coding errors

Resubmitting the claims in adherence to the timely filing limits

Appealing unjust denials with proper documentation

Putting procedures in place to prevent similar issues from happening again

An experienced claims resolution team improves collections and increases the efficiency of your revenue cycle allowing your staff to place their focus on patient care.

 

Why RCM Services Are Essential for Healthcare Providers in the New York Marketplace

 

To succeed in the crowded and highly regulated New York healthcare marketplace, providers need to operate at their utmost efficiency. With rapidly escalating administrative costs and dwindling reimbursement rates, The vast majority of private practices, clinics and specialty providers are looking to RCM professionals for help with their financial wellbeing. 

 

Advantages of hiring a New York provider for your RCM services include:

 

• Rapid Payment Processing: Efforts made by specialists and clean submissions mean reimbursement will take less time and happen faster. 
• Lower denial rates: Professional monitoring and cleaning will help prevent denials from New York insurers.
• Higher collection rates: Custom A/R strategies can have higher recoveries rafts on old or past-due claims. 
• Regulatory compliance: Maintain compliance with New York healthcare laws and rules from payers. 
• Elevated focus on care: Be free to let your team focus on what you do best – providing exceptional patient experiences. 

 

Choosing a RCM Partner in New York

 

Not all RCM services are the same. If your practice is located in New York, you will want to choose an RCM partner that is well-acquainted with the dynamics of healthcare in New York, and has experience with payor sources, including Fidelis, EmblemHealth, Healthfirst, and UnitedHealthcare of New York.

 

Important factors to consider are:

 

• Knowledge of New York Medicaid and commercial insurance policies
• Experience working with local hospitals and specialty practices
• HIPAA compliant software integration
• Real-time reports on performance dashboards
• Transparent billing and assigned account managers

 

Whether you are a solo provider located in Bronx or a growing multi-specialty group located in Manhattan, having a customized RCM solution can mean the difference between a practice thriving or surviving.

 

Real Results for New York Providers

 

Many healthcare organizations in New York have experienced dramatic improvement to their financial performance by outsourcing A/R recovery and claims resolution. These improvements range from a reduction in the amount of A/R over 90 days delinquent to enhancements in first-pass resolution rates. Professional RCM services can provide measurable results.

 

Think of the potential to move from chasing payments to growing your practice. This is what effective and strategic revenue cycle support can accomplish when customized for the New York market.

 

Final Thoughts

 

Healthcare providers in New York are faced with some of the toughest financial and operational challenges in the country. The cost of care is rising, there are considerable rules and regulations regarding reimbursement and reporting, and the insurance market is complicated and constantly changing. While maximizing revenue is essential for any practice, for the New York provider, maximizing revenue is often obligatory rather than an option.

 

With professional Revenue Cycle Management, more specifically Accounts Receivable Recovery and Claims Resolution Support, a practice can achieve established revenue cycle and accounts receivable goals, gain financial stability or profitability, and provide effective financial care without the leading barriers to progress within the billing process.