The Medical Billing Cycle Explained: How LTPAC Practices Get Paid Faster

Long-term post-acute care (LTPAC) providers face many challenges in their attempts to get paid on time. Insurer denials, billing errors, and documentation gaps are just a few factors that can lengthen the time it takes for LTPAC practices to be reimbursed for their services rendered. 

Anything that can shorten the billing journey is helpful for maintaining profitability. Some electronic health record (EHR) solutions possess revenue cycle management (RCM) functionalities to consolidate LTPAC billing and documentation workflows, but not all of them have the specialized features to handle the complexity of these facilities. 

Explore what is the RCM cycle in medical billing​ and the difference between medical billing vs. revenue cycle management for LTPACs, as well as what causes payment delays. We'll also show you how EHR/RCM tools help overcome the obstacles in the medical billing cycle, and how a partner like ChartPath delivers what others only promise.

Why the Medical Billing Cycle Feels Different in LTPAC

The medical billing cycle consists of the steps required to bring full payment into your facility for all services rendered. From patient pre-registration to payment posting to collections, a medical billing claim can have a lengthy lifecycle. This is especially true for LTPAC providers, where financial, operational, and strategic challenges can extend payment times and create cash flow complications. 

• Financial: Billing and coding errors, prior authorization requirements, and complex policies from organizations like Medicare and Medicaid can lead to denials and payment delays, hindering LTPAC providers' solubility. Providers often treat patients with higher deductibles who may have some confusion regarding their financial obligations, further straining your cash flow when it's time to collect.

   

• Operational: LTPAC physicians are often understaffed and have little time to dedicate to RCM workflows. Legacy EHR/RCM tools may also lack efficiency-boosting functionalities like billing automation, forcing your team to perform LTPAC billing by hand and slowing them down even more. 

   

• Strategic: LTPAC facilities often face a lack of financial visibility in their RCM operations. Inadequate analytics and data make it difficult to monitor key performance indicators (KPIs), identify revenue leakage, and forecast future cash flow, creating inefficiencies that weigh down your revenue cycle.  

Skilled nursing facility (SNF) workflows, payer rules, MDS assessments — LTPAC providers face many unique challenges that add complexity to the RCM cycle in medical billing. That's why they need a tool tailored specifically to RCM workflows to streamline their medical billing cycles.

Step-by-Step Through the Cycle: From Intake to Payment Posting

The claim cycle in medical billing is a long journey, and physicians may encounter different difficulties with each step. Here's a sample life cycle of a medical billing claim, with the obstacles that an LTPAC provider could run into along the way: 

1. Patient Registration, where teams collect the patient's demographic data, medical history, and insurance details to prepare for further processing. Issues with staffing or outdated technology could make this step more time-consuming for physicians. 

2. Insurance Verification & Authorization, where teams confirm benefits and secure pre-authorizations to prevent denials beforehand. Complex requirements from Medicare and Medicaid may make this process difficult for LTPAC providers, increasing the likelihood of a denial. 

3. Service Delivery & Documentation, where clinicians provide care and document it correctly. LTPAC groups and SNFs must complete additional tedious documentation, such as MDS assessments for Medicare and Medicaid, and submit them to CMS.

4. Coding & Charge Capture, where services are translated into CPT or ICD-10 codes based on documentation. Inaccurate coding can result in claims denials or reimbursement delays for LTPAC groups, straining their cash flow.

5. Claim Preparation & Submission, where billing departments submit claims through integrated EHR or RCM systems. LTPAC groups may rely on siloed systems that fail to communicate with one another, leading to billing errors.

6. Claim Tracking & Adjudication, where a claim's status is monitored while payers review all coverage and payment requirements. LTPAC providers often face longer payment times than other clinical settings, remaining in the tracking stage longer than usual. 

7. Payment Posting, where billing personnel record insurer payments, partial payments, or denials. A higher denial rate further strains providers in the payment posting phase, forcing them to track payments when they're already understaffed. 

Outdated technology, poor visibility, understaffing, and limited resources can impact revenue cycle management in medical billing at nearly every step in the journey for LTPAC providers. Fortunately, by understanding why these breakdowns occur, you can take measures to stop them and repair any revenue leaks, improving your profitability. 

The Breakdown Points: Where Delays, Denials & Documentation Gaps Begin

Identifying where RCM bottlenecks occur is one of the first steps in improving healthcare billing processes. The exact issues that each RCM team experiences will vary, but some of the most common are:

• Incomplete documentation. Clinicians provide a wide range of services during rounding, but documentation gaps may cause some services not to be reimbursed or billed for at all. An EHR system that also has RCM functionalities can ensure that all treatments are fully documented so that they can be fully billed. 

• Inaccurate coding. Coding errors can cause denials or delayed payments, forcing claims to remain in the Tracking stage for longer. This extends Accounts Receivable (AR) periods and strains your cash flow — if the claim gets paid at all. 

• Compliance violations. Complex regulatory requirements can create confusion for billing teams, leading to a compliance violation or lower reimbursement rates. 

Some LTPAC physicians are implementing charge capture applications to address their medical billing struggles. These tools reduce the risk of revenue leakage by recording clinicians' services automatically. This reduces the number of documentation or coding errors, while aligning with the leading healthcare standards. The result is a more accurate, streamlined billing process, with fewer compliance violations. 

Smart RCM and Automation: The Real Billing Power Duo

With such a high workload, LTPAC groups need more than an EHR tool with RCM functionalities — they need a platform with billing automation features built in to boost their efficiency. EHR/RCM tools like ChartPath go beyond the medical billing cycle to support every stage of your processes. 

For example, features like coding support help you reduce billing errors during the Coding and Charge Capture phases, minimizing delays and denials. Pre-claim checks confirm that any information is submitted correctly, and automated eligibility scans help you establish prior authorization beforehand, ensuring that all services are reimbursed. ChartPath's interoperability also helps ensure the proper documentation of all services so that your facility can bill for them correctly the first time, maximizing your reimbursement.

The RCM puzzle is complex. Why simply survive it when you can thrive with a partner that has all the necessary ingredients baked in? When your EHR software integrates the leading RCM functionalities, it minimizes EHR money loss risks, so that your LTPAC group can finally get paid on time. 

When Your Billing Tools Hold You Back (And What Better Looks Like)

Legacy tools, staffing issues, and complex payer requirements can frustrate clinicians in LTPAC settings, understandably. A specialized end-to-end tool like ChartPath can simplify billing cycles, shortening your RCM journey and helping your facility get paid faster. The result is fewer delays and denials, smoother cash flow, greater profitability, and less frustration for your clinicians as well as your patients. 

While many players may promise improvements in your RCM processes, ChartPath is proven to deliver. Reach out for a live demo to see how ChartPath can elevate your RCM processes today.