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No RCM Pain, No RCM Game?

by MiddleGate, on May 2, 2019 7:54:36 AM

Can't Handle the Pain Anymore?

Every Payer has their own set of rules that are constantly changing and it is making it difficult for revenue cycle to keep up.

"These changes make following up on payments extremely hard on me and they seem to be changing their behavior." - RCM Expert and Medical Billing Company Owner.

See Below: Over the same time period and for the same biller, we discovered radically different behavior between two Payers (Fig. 1, Fig. 2)*: 

(Fig. 1) Analytics showing the behavior of a Commercial Payer ABC in Florida

*Green and flat is normal expected behavior. Red and orange are dramatic shifts in behavior. 



(Fig. 2) Analytics showing the behavior of a Commercial Payer XYZ in Florida

Shifting behaviors are causing organizations to find their revenue cycle metrics falling outside of acceptable measures. These metrics include:

  • Increased Denial Rates
  • Decreasing First Pass Payment Rate
  • Increase in Days in A/R
  • Reduction in Net Collections Ratio

A/R teams are seeking solutions that provide the necessary transparency to help improve revenue cycle performance.

Topics:Revenue Cycle ManagementArtificial IntelligenceMachine IntelligenceThe Claim GameRCM


About MiddleGate

MiddleGate delivers technology solutions to improve revenue cycle management. Get the latest updates on our blog where we aim to deliver relevant, cutting edge news and commentary on technology issues within medical billing and RCM. 

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