Healthcare organizations are reevaluating revenue cycle approaches. When it comes to patient care, as reflected on the UB-04 claim form, hospitals know well that before a bill is even created, it all originates down the continuum.
An increase in bad debt and/or AR days is usually the catalyst for action. The primary objective of CEOs is to receive full compensation for their services. However, they face a problem in ensuring that charge integrity and HIM actions lead to beneficial revenue and quality outcomes.
Many healthcare organizations face a threat to their financial stability as a result of reimbursement issues, such as appeals and denials. Prepayment review vendors are being used more frequently by payers to dispute individual line items before payment is made.
So, how can your healthcare business enhance its revenue cycle and reduce the number of claims that are denied? Consider following these eight helpful guidelines:
Outsource Medical Billing
Hiring a specialist to handle your medical bills is a simple method to boost efficiency. It is also the means by which a lot of other businesses are bettering their own revenue cycle management. If you want to get freedom from the stress of dealing with revenue, partnering with revenue management is the way to go.
Your revenue cycle manager will try to find ways to streamline your operations so that you can collect more charges and get paid more quickly. Hiring a professional is always a smarter option when you’re trying to improve.
Regularly Monitor The KPIs ( Key Performance Indicators )
Maintain vigilance over the variations in claims filing and invoicing to spot problems in advance and address them as soon as possible. In particular, keep an eye on the frequency with which patients miss appointments despite repeated reminders, the time it takes to settle up the bills, and the reasons why claims are denied. Do you feel like this would be a burden in terms of patient care? If you need help with revenue cycle management, you can always hire a professional service. If you outsource medical billing and coding, you can concentrate on running your healthcare business instead of micromanaging the details.
Establish A Revenue Cycle Committee
To help your company see the revenue cycle as a continuous process, consider forming a revenue cycle committee. The primary responsibility of the committee should be to pinpoint the specific points along that scale where things are off and then provide solutions. Your ultimate goal should be to transform your company into a “learning organization” capable of pinpointing and fixing problem areas in the revenue cycle.
Your revenue cycle committee may, for instance, discover that many claims are being denied farther down the line because patient eligibility is reviewed on the day of treatment rather than during scheduling. Then, you can make the requisite adjustments to the scheduling procedure to ensure eligibility.
Perform Annual Audits To Identify & Reduce Claim Denials
Even though claim denials may appear unavoidable, they can be mitigated to a certain degree by instituting checks at various stages. Repeated claims processing problems can be investigated and, hopefully, resolved with the use of internal audits. Claim denials can occur for many different reasons; a frequent audit can help identify these causes and alert relevant teams or personnel so they can educate themselves and prevent future occurrences. A better starting point for increasing income is decreasing the number of denials.
Implement Modern Coding Practices
More money will come in, and fewer insurance claims will be denied if coding standards are widely adopted. Health centers may keep patients happy and avoid fines from regulators by maximizing their adherence to coding standards. The revenue output and the assurance of compliance with policies and procedures can be considerably improved by outsourcing these operations to specialists and professionals who offer end-to-end services in clinic management, including a one-stop revenue-cycle-management solution.
Obtaining Payments In Advance
Another reason to use an automated workflow system is to guarantee timely payments, which is important regardless of whether or not patients have a preference. Revenue cycles in healthcare are slowed by patients’ late or insufficient payment of their shared financial responsibility. Providers can help patients better grasp their financial obligation by providing upfront cost estimates generated by an automated workflow system.
One way in which providers might improve RCM is by requiring patients to pay in advance. Automated systems can be set up to accept payments from patients at the point of service or in advance of their service delivery. In addition, these infrastructures support credit card-on-file services, which can significantly improve cash flow by expediting payments.
Moreover, providers can prevent financial hardship caused by payment delays or loss if these procedures are strictly adhered to.
Modernize Claims Processing
Before submitting claims to insurers, scrubbing is done to ensure accuracy, correctness, and completion. It is a simple method to increase the likelihood of quick payment, and it is another job that lends itself nicely to computerization.
Claim scrubbing is no longer a time-consuming human operation thanks to cutting-edge software that automates previously laborious steps. There’s just no reason your practice should ever submit a claim that hasn’t been verified by your in-house clearinghouse.
Hiring A Proficient Billing Partner
Your billing firm will only see the results it expects if you have the experience and competence to handle every aspect of Revenue Cycle Management. However, it may be difficult to find and keep skilled employees at times. Although, with a Medical Billing Outsourcing Company overseeing your revenue cycle management, you don’t have to stress yourself in such areas. Recent studies have shown that outsourcing to countries outside of the United States is the optimal method to survive the current economic crisis.
In order to adapt to new developments in medicine and patient care, the healthcare sector is always evolving. The physician and the patient both stand to gain from the ongoing rollout of innovative new practices. Consequently, hospitals and clinics should always be looking for ways to boost their revenue cycle management.
Effective and efficient RCM can be achieved with even a few well-considered actions. A healthy business with consistent income creation and a streamlined RCM process. Furthermore, working with the best in the business can help you save resources without lowering the standard of your clinic’s administration or the treatment your patients receive.