Revenue Cycle Management
Some changes in healthcare are now requiring hospitals to take a serious look at their revenue cycle management program. One major change is consumers now bear an increased financial responsibility for their healthcare costs, which means the financial pressures on healthcare organizations will continue to increase. You must re-evaluate your existing systems and possibly check into new solutions to improve access management, accelerate cash collection, and improve payor performance. You must also address today’s transient patient populations and transient healthcare teams.
Some areas to focus on include:
Access management:
Once a patient leaves your organization, the chances that they will pay their bill in a timely manner or at all drops drastically. With more and more people going to self-pay options, you have to be proactive in capturing this revenue. Also, to lower your bad debt, you have to have alternative payment options for patients or charity care qualifications at time of registration or during pre-authorizations.
· Pre-Authorizations will save time and frustration for your patients – if you know before the procedure is scheduled what will or will not be covered, and have that conversation with the patient and have an ABN signed and/or payment plan agreed to before scheduling there will be less confusion
· Ensure you are performing medical necessity checks during scheduling, admissions, and at the time orders are placed and issuing an ABN if necessary
· Perform address validation (electronic systems are better than asking the patient since they will not always tell you a new address)
· Propensity to Pay helps you predict the likelihood of a patient to pay the self-pay portion of the bill
Accelerate Cash Collection:
Once the services are performed, if you have streamlined the billing and collection process, you will get reimbursed faster and reduce your A/R days. Use of these techniques will help accelerate your collection time:
· Electronic Claim processing
· Direct entry of medical claims
· Automatic secondary billing
· Electronic remittance postings
· Document image retrieval
· Utilize contract and denial management electronically
· Perform financial analysis
· Have an online payment system (one that is integrated with a portal so patients can view results and contact their provider and make payments all in one place is better than having them log into two different systems)
· Accurate coding (if you document inaccurate codes, you can get a lower reimbursement, but also look because those codes may be a result of insufficient documentation to allow proper coding or you don’t have sufficient information from a referring physician)
· Lack of efficient denial management
· Managed care rates set too low
· Focus on high write-offs, denials, and days sales outstanding to see what changes can be made to lower the amounts of these items
Improve Payor Performance
· Utilize electronic analysis and reporting capabilities to monitor payor contracts
· Cost Accounting tools will provide detailed information about patient utilization and outcomes, so use the systems that come with your EMR system or electronically pull that data into another analysis tool. Some organizations still use spreadsheets and manual data entry which takes time and is also prone to human error.
