Small practices lose an estimated 15-25% of potential revenue due to RCM inefficiencies like billing errors, claim denials, and compliance issues. Outsourcing to Transcure professionals experienced with NextGen RCM processes helps reduce these losses, with experts predicting a 6%-10% revenue improvement through more efficient billing procedures. This reduction in errors and improved cash flow is crucial, especially as small practices face financial instability from high operational costs, regulatory challenges, and the complexities of managing electronic health records.

Without the latest billing services and ICD-10 revisions, small practices often struggle with insurance claims, leading to further denials. However, partnering with an end-to-end RCM  provider company like Transcure provides end-to-end revenue cycle management solutions, allowing practices to offload these challenges and focus on delivering quality patient care. In this blog, we will explore five small practices that can benefit most from NextGen RCM outsourcing.

Did you know that RCM is one area where large healthcare systems tend to outperform small practices? 

Large healthcare systems often have access to state-of-the-art technology, including medical software and EHR systems. These advanced softwares streamline billing integration, reduce errors, and enhance data security. On the contrary, managing a small practice presents its own set of challenges, particularly in medical billing. Often, they even lack the resources and tools needed to handle their RCM services effectively.

This leads to financial instability, which is a consequence of high operational costs, regulatory compliance issues, and the workload associated with maintaining electronic health records. In addition, the inability to keep up with the latest ICD-10 revisions can eventually lead to problems communicating with insurance corporations, eventually leading to claim denials. 

Complexities Small Practices Face In Their RCM

Small practices often lack the resources and expertise to handle their revenue cycle efficiently. According to research, up to 25%-30% of all revenue loss is due to claim rejection and old-school administrative processes. This is because these practices usually have limited budgets for investing in technology and hiring experienced staff. 

Here’s where the complexity lies:

Increasing Complexity: The healthcare landscape is becoming increasingly complex, with new regulations, technologies, and payment models constantly emerging. 

Denial Rates: Many small practices report high claim denial rates, which can significantly impact their revenue.

Frequent Pre-Authorizations: Many insurance companies require pre-authorization for specific treatments and surgeries. Securing these authorizations can be time-consuming and requires detailed documentation.

It’s better to invest in outsourcing Nextgen’s services, which can help your service in the long run with the least hassle of managing an in-house staff. Transcure employs your NextGen tools and provides solutions designed to streamline operations by providing advanced analytic tools for these issues. These steps require meticulous attention to detail to ensure a smooth transition and avoid disruptions to your daily operations.

1. Primary Care Practices

A primary care provider (PCP) is usually the earliest point of contact for a patient seeking medical assistance. As the backbone of the healthcare industry, the influx of patients makes handling coding and billing a time-consuming task. Studies show that a single PCP can lose up to $124,435 annually in unbilled or incorrectly coded preventive services. This is because providers face difficulty in navigating coding and billing as they struggle to capture revenue from the services they provide. NextGen offers several solutions tailored to address this:

• Precise Eligibility Verification

Since eligibility verification is the basis of the claim, the billing staff must verify the patient’s insurance efficiently. They must check coverage for all the diseases listed and to what extent. According to industry studies, up to 80% of medical claim denials are due to issues with insurance eligibility. The leading cause of these denials can be the following:

– Incomplete or error potent documentation.

– Including any services that the insurance company doesn’t cover.

Transcure’s Nextgen RCM services help reduce comprehensive training in managing claims, post payments, and denial management. TransCure uses these tools for error-free recording of the demographic area and insurance info, along with the ID docs. This results in a careful reduction of any risk.

• Error-Free Automated billing

NextGen RCM uses automation for coding and billing. But sometimes, coding needs human attention to integrate the latest codes to avoid denials. This minimizes work, speeds up collections, and cuts AR by 30%. It is crucial for practitioners who handle a wide range of services, from scheduling appointments to taking care of chronic patients. Transcure has 1100+ certified billers who work around the clock to provide you with faster reimbursements while taking care of the backend.

• Claim Processing

Managing claims along with routine checkups and a busy schedule can be overwhelming. That’s why it’s essential to submit claims in a timely manner to ensure accurate processing and prevent patients from having to pay out of pocket. Even minor errors in diagnosis codes can cause claim denials. 

Transcure’s expert coders convert medical billing services into precise codes that comply with HIPAA and SOC-1 regulations. Using the NextGen EMR system alongside ICD and CPT coding standards, we help streamline your billing process, reduce errors, and accelerate reimbursements—allowing you to focus more on patient care and less on paperwork.

2. Pediatric Practices

Pediatric billing and coding are different from other specialties. Billers must fully understand small components, like vaccines. This basically means that mismanagement in coding for preventive services like vaccinations or well-child visits can result in higher denial rates, which is a common issue in this practice. Pediatric practitioners focus on the healthcare needs of children, which requires transparent reporting and documentation. They have a high patient volume due to frequent visits for routine care, vaccinations, and urgent care services, leading to administrative overload. Integration solves all critical issues with automation and communication. Here’s how outsourcing NextGen’s rcm services help you manage administrative tasks while you focus on patient care :

• Revenue Cycle Efficiency

Small practices often lack access to advanced technology, making their billing processes more prone to errors. Addressing these billing challenges before they affect your profits can feel overwhelming. Transcure, along with NextGen RCM services, handles all aspects of your claims, from preparation and submission to denial management. This reduces your administrative workload while improving accuracy and speeding up reimbursements.

• Customizable templates

NextGen medical software comes with customizable templates specifically tailored to the needs of pediatric healthcare. Maintaining in-house billing services can be difficult, so these templates help streamline common services like child visits and developmental screenings. Its user-friendly interface helps you track the eligibility process. At the same time, you can focus on building a solid relationship with your patients.

• Patient Engagement

In case the insurance company does not cover the billing costs, then the bills are sent to the patient by the medical billing company. If the patient doesn’t cover their payments during the given time frame, then the company sends them a reminder. After a specific period, if the payment is still not made, then the account will be transferred to collections. For example, after 90 days, the account is sent over to the collections agency to collect the remaining debt. 

TransCure helps small pediatric practices improve customer experience through transparent reporting, personalized communication, and better AR management. The focus is on the convenience of immediate statements and seamless online payments, which ensures a patient-centric financial experience. This not only provides customer satisfaction but also boosts collection revenue.

3. Mental Health Practices

In recent years, the extent of mental healthcare has primarily enhanced. Mental health practices, like therapy and counseling, face complexities with medical billing due to their high patient volume. Additionally, they may struggle with navigating the different coverage policies of insurers, including Medicaid, which often have stricter guidelines for mental health claims. These practices must also adhere to strict privacy regulations, making it difficult to stay compliant. Following are the problems mental health providers often face:

• Complex Billing Scenarios

Mental health practices often use billing codes that are complex from those of their peers. Accurate coding is necessary for proper reimbursement. If a provider provides a specific treatment, then they must use the correct CPT-10 codes to deal with the level of complexity. With codes and regulations constantly changing, it’s challenging to keep up-to-date with these systems. NextGen Healthcare EHR services support these billing scenarios. 

• Confidentiality and compliance

Protecting patients’ confidentiality is paramount for mental health practices. The key is to maintain confidence and ensure high data security, which helps practices stay HIPAA-compliant. This involves secure handling of billing records and ensuring the patient data isn’t exposed to the general public. Any accidental sharing of this information can cause significant penalties. 

• Integrated Scheduling and Billing

Scheduling patient visits while running a small practice can create billing issues mostly due to the lack of administrative power. Providers often use EHR systems, which must be integrated with billing software. Leveraging TransCure with NextGen RCM provides a comprehensive platform that integrates with electronic health records (EHR) and practice management systems. This integration streamlines managing appointments, tracking visits, and ensuring timely practice management.

4. Specialty Practices

Specialty workers often work with complex procedures and treatments that require specialty knowledge in billing and coding. Your practice’s specialty dictates revenue cycle workflows. For example, cardiology may use different codes for various cardiac stress tests, echocardiograms, or interventional procedures. Here’s how NextGen RCM offers support services to ease the burden for small specialty clinics: 

• Procedure-Specific Billing

Outsourcing medical billing services can be beneficial, especially for small and independent practices. Transcure provides treatment-specific solutions to every case with affordable and reliable billing services. It uses up-to-date codes, which can be challenging to stay updated on as these codes change often. They keep up with the demands of each specialty and adhere to new regulations. These services reduce your burden by significantly reducing billing errors while accelerating the billing process.

• Authorization Management

Complexities may arise due to the nature of the care they provide, the conditions they treat, and the advanced procedures they use. Many specialized treatments require authorization from the insurance company before being performed. Navigating insurance policies can also be a hefty task because various insurance providers have different requirements for authorization and referrals. Any delays in beforehand authorization can lead to revenue and billing delays.

• Revenue Cycle optimization

Different specialty practices must follow the clinical guidelines of each treatment for diagnosing the patient. In the same manner, various procedures and treatments have varying reimbursement rates, even if they are in the same condition. These practices also have high operational costs due to the need for specialty-specific facilities, staff, and equipment, which need to be integrated with the NextGen EHR. At Transcure, we leverage NextGen EHR to streamline your financial operations, from tracking reimbursement rates to managing operational costs. So, specialty practices can focus on delivering exceptional care while we handle the financial complexities.

 5. Rural Practices

Rural hospitals are often the only healthcare option for people in sparsely populated areas, but they face significant financial challenges due to high patient volumes. This is because they operate with fewer resources, geographical isolation, patient demographics, and healthcare integration. This can mean fewer persons dedicated to billing and limited access to advanced technology. Without modern RCM technology, these issues lead to longer claim processing times and inefficient collections. Outsourcing NextGen RCM addresses key challenges faced by small rural practices by providing expert management.

• Scalability and Flexibility

As patient volumes grow, outsourcing offers seamless scalability without the need for additional in-house staff or infrastructure while granting access to advanced RCM technology that may otherwise be cost-prohibitive. Ultimately, outsourcing allows practices to focus on delivering quality patient care, freeing them from the complexities of revenue cycle management.

• Telehealth Integration

Telehealth benefits rural residents with limited access and transport to the facilities. In this ever-changing world, making healthcare accessible certainly has its intricacies, which can be overcome with the right combination of technology and collaboration. Numerous clinical trials and case studies have proven the effectiveness of telehealth and remote patient monitoring in supporting these objectives. NextGen medical software integrates smoothly with telehealth to optimize collections, compliance, and revenue.

• Reduce AR

NextGen AR management can ensure a steady cash flow and avoid legal issues and penalties by ensuring billing services follow healthcare regulations. If payments are very overdue, a collection agency can be involved to ensure the best billing. At Transcure, we leverage NextGen EHR to streamline your financial operations. 

Here’s How You Can Tackle RCM Challenges with TransCure

Partner with NextGen EHR experts like Transcure to optimize your billing procedure. In order to focus on patient care, our staff streamlines your billing process. We automate scheduling tasks, ensure swift eligibility verification, minimize denials, optimize claims processing, reduce patient bad debt, and access advanced analytics for a comprehensive understanding of financial health. By integrating industry best practices and our NextGen knowledge, we provide a full range of RCM services.  

Conclusion

In today’s rapidly changing healthcare environment, small practices across different specialties face several obstacles when it comes to efficiently managing their revenue cycles. These problems, ranging from complicated billing procedures to frequent claim denials, can seriously affect one’s ability to maintain financial stability. However, small practices can increase their billing efficiency, boost reimbursement rates, and concentrate more on patient care by working with a reputable solution like NextGen RCM. TransCure’s proficiency in merging NextGen EMR and RCM services guarantees smooth operations, minimized mistakes, and adherence to industry standards, thereby enabling small practices to flourish and improve their financial well-being.

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