As patients take on more out-of-pocket costs, and patient satisfaction continues to influence the financial health of hospitals, revenue cycle management has become increasingly important to organizations.
Amid these and other changes, many revenue cycle professionals have offered thought-provoking insights.
Here are 10 RCM tips from industry experts:
1. “To make sure that your organization is quickly paid what it is owed, make sure that claims are coded right the first time — a task that has become more challenging since the advent of ICD-10 which has over 68,000 coding options compared to the 13,000 ICD-9 codes. Look for a set of automated coding tools that integrate with your claims software to ensure compliance with local coverage determination and national coverage determination regulations. These systems also allow you to search within specific sub-sets so only codes relevant to your practice or organization appear in search results.”
2. “Gather your data and select a few areas of opportunities to stay focused on, in order to make a positive impact. To this day, the old management adage of, ‘you can’t manage what you don’t measure’ is true. I feel by setting priorities in a methodical way, and maintaining our focus, the [revenue cycle] team is engaged and empowered to make change.”
3. “The objective of a charge capture analysis is to improve charge capture processes by mitigating compliance risk, identifying potential missed revenue, and producing cleaner, more compliant claims. It is important to review the entire charge process at the point when services are converted to a financial transaction, through the claim scrubbing, and back end billing edits. It is also important to understand where errors or missed charge capture happen throughout the entire billing cycle. Focusing on pre-scrubbed claims does not always reveal errors with back-end processes. These processes include but are not limited to inaccurate coding, missed charges, incorrectly worked claim scrubber edits, inappropriate charge removal/additions and late charges.”
4. “Time is precious — especially when you are resolving revenue cycle issues. Higher level management may not always have time for creating agendas and meeting minutes to document critical issues but it’s important to communicate on issues so that productivity is enhanced, mistakes are not repeated, and revenue is not affected.
“One way you can prepare for meetings but spend your time effectively is to eliminate a meeting agenda and meeting minutes and instead prepare an action log. Action logs keep meetings on track, prioritize issues, assign tasks, and creates a time to follow-up on meeting items. They also make the meeting focus more on resolving current issues to enhance revenue. Use your time wisely in maximizing your revenue by … utilizing action logs for immediate resolution, and document when the issue has been resolved.”
5. “Many healthcare organizations are still using outdated processes or paper-based workflows for denials management. Eighty percent of healthcare organizations don’t have technology for denials management now. With denials and underpayments increasing, it is imperative to apply technology and resources to their management. This will result not only in better management of denials, but in denials avoidance — by uncovering problem areas upstream in the revenue cycle, as early as patient registration. It no longer makes sense to use old tools to tackle increasingly complex denials issues; investment in denials management is an investment in the future financial health of the organization.”
6. “The clarity and perspective that technology provides to physician advisors when reviewing cases and providing medical necessity recommendations not only drives greater efficiency, but also establishes consistency from one review to another. By applying the same considerations to cases with similar clinical backgrounds and presentations, embedded guidance from a technology platform introduces a standardization of documentation and methodology which facilitates widespread acceptance of the clinical review process. As a result, clinicians can more easily generate an accurate and compelling case narrative for payers, as well as demonstrate a higher degree of inter-rater reliability — both of which lead to fewer denials down the line.”
7. “From check-in to the insurance verification to billing, data analytics can help you identify where the biggest opportunity for improvement lies. Are patient no-shows causing you to lose money? Data analytics spots these trends and help you course correct the problem (i.e. set up appointment reminders for patients).”
8. “Even with everyone glued to their smartphones these days, it’s not enough to build patient payment portals and think they will come to pay their bills. While undoubtedly essential, technology cannot replace the power of personal interactions when dealing with patients about their medical bills. So give customer service reps the authority to waive late fees or offer an extension if a patient loses a job or suffers another financial setback. Go even further with such old-school tactics as having service reps call patients to check in after their first payment and send thank-you notes when they’ve paid off their balance. Keeping the personal touch will go a long way to building patient financial engagement and loyalty.”
9. “Although many may see the IT department as the owner of an initiative like MACRA, true progress can only be achieved from a cross-departmental collaboration among financial, clinical and IT departments. Financial leaders serving on this committee should be responsible for managing the organization’s reporting path, including working with clinical leaders to select the appropriate program measures under either the APM or MIPS track. After all, these program measures are critical in charting the organization’s path for quality reimbursement opportunity; it’s imperative for an organization to select the measures it can meet most easily. By taking a key role in MACRA initiatives, financial leaders can help their organizations maximize reimbursement and prevent penalties in future years.”
10. “We all know that people look at their billing statements, which we estimate have an open rate of 95 percent or higher for existing customers. So use the prime real estate on those bills to add marketing messages and educational information to improve customer engagement and create stronger relationships. One eye-care network, for example, includes the dates, locations and fees for its educational seminars. Or send heart patients information about cardiac-related wellness programs in their billing statements.”
For more info: 10 revenue cycle tips for healthcare organizations