Strategies to Proactively Drive Revenue Cycle Efficiency and Reduce Cost
Managing the revenue cycle in healthcare businesses can be costly. However, if insufficient measures are taken to oversee good billing processes, collectible revenue is often left on the table. Constant annual changes in billing and coding rules make the processes especially frustrating, but smart strategic planning using relevant internal and external resources can help maximize efficiency and reduce costs, thus making the business more profitable.
It’s always important to monitor a few internal figures to identify claims issues. In addition to the daily review of electronic claims denial reports, several monthly agings should be reviewed, including by provider, insurance, and location of service (i.e., by office and hospital, or by a specific hospital if your software has the capability). These reports help isolate a problem source, which can be further examined for common patterns contributing to the lack of payment. Such patterns include no response to claims sent to a certain carrier, which might mean a corrected address is needed. If office claims are denied on established patients, staff might not be getting the information updated at check-in. Or, if a particular provider’s claims are unpaid longer than the others, he or she might need to be educated to provide sufficient information for coding. Review these additional reasons for claims denials, and how you can prevent them.
A Coding Partner Is A Valuable Investment
The services of a coding partner can be a valuable investment for preventing root causes for claims denied. With rules changing yearly, and sometimes quarterly or even monthly, requesting a periodic analysis can provide your business with some easy to digest reports that provide helpful insight into what might need some extra attention in your revenue cycle processes.
Revenue cycle management efficiency can also be improved by staying abreast of potential changes in insurance requirements or issues your peers have experienced. Listening to partners/third parties that your providers work with, such as auditing and coding support consulting companies, like YES, can be a valuable resource for this information. Becker’s Hospital Review provides some perspective on revenue cycle management in this article. Additionally, professional associations for groups such as physician specialties, mid-level providers, pharmacies, etc., often have monthly newsletters and/or articles on their websites regarding billing matters that impact their members. Insurance carriers, too, will sometimes report in their newsletters and website entries that certain coding edits will be added to their systems and claims that don’t pass those edits will reject. Don’t forget that insurance provider representatives can be valuable to help resolve ongoing claims and other insurance matters, so know who they are and maintain good relationships with them.
Having Certified Coders On Your Staff Is Key To Revenue Cycle
Coding is always a key factor in healthcare billing, and keeping your coders up-to-date on rules and new or revised codes is essential to successful revenue cycle management. Having certified professional coders on your staff establishes a solid skill foundation, and as discussed in this article, providing ongoing continuing education by nationally recognized educators ensures that your staff will stay current with codes and coding rules.
Revenue cycle management is complex and not likely to get easier, although practical resources are available. Strategic use of useful outside information (from certified external partners) along with inside monitoring and solid practices, can result in a very proactive drive in revenue cycle management.