October 9, 2013
The revenue cycle is a complex process. It’s not an easy undertaking to make sure you’ve taken all the right steps to protect your ability to be paid for every patient coming into your facility.
What helps the process go smoothly is for all players from the front, middle and back of the revenue cycle to communicate more effectively. Effective data gathering, prior to services being provided, strongly enhances the likelihood you will be paid more timely and completely for the services you provide.
When you don’t have a system in place to make sure paperwork is flowing correctly, not only are you at real risk for not being paid, but the hospital may end up paying the cost of services you ultimately are providing for free. That’s a big hit to the bottom line.
So how do you know if you’re protecting your revenue?
How can you be sure that you have everything in place to allow your team to be paid for services they render today but also protect from audits and take backs down the road?
Take a look at these five steps given by Becky Black, VP of Revenue Cycle at Southern Regional Medical Center, and compare them to your current processes. Then see if you have the right tools in place to help you along the way.
Track collections compared to net patient services revenue. In fact, someone should be tracking this over time. If your organization isn’t tracking statistics related to denials , both initial as well as final, you need to be asking why not. How are your cash collections compared to your net patient service revenue? Over time it should trend out to 100%.
You can’t attack problems if you don’t know what the root causes are.. If your overturn rate is very low, you need to increase your skill set and learn how to write appeal letters. Leverage all that you can. Sometimes you absolutely have to have third parties to help you with this because insurance companies by nature make it very hard; they do not want to pay you.
Find out the volume of your denials, both clinical and technical. Review the time/effort needed to effectively work these claims. Utilize tracking tools and databases to track needed information. This may be where your bottom line is hiding! It costs staff-time and money to have denials reviewed and appealed. Make sure staff is using their time wisely and not letting denials fall off the radar. This is especially true of lower reimbursed claims, as they do add up.
Anyone from billing can tell you that if a patient had a bad experience, you generally don’t hear about it until they get their bill. That’s why it’s very important to use a recording technology like Trace. That way you can record conversations about payment arrangements to ensure that the patient has a clear understanding of his or her financial responsibility. If there is later a concern or dispute about whether the patient was accurately informed, you have an objective source to defend your position.
Cancelled procedures are getting to be a huge cost for hospitals, and they are a frustration for everyone involved – hospitals, physicians and especially patients. Use Trace to track where the paperwork goes and why, as well as phone conversations with both the patient and doctor’s office. Then you can know what happened and either avoid a cancelation all together, or prevent them in the future.
Hospitals have to run very efficiently to protect current revenues and add back to the bottom line. There are so many hoops to jump through, and it’s only going to get more complicated.
Communication is critical to effectively tackling denials and harnessing information to drive revenue cycle performance. Cover all your communication bases with Trace and you’ll have the proof necessary to eliminate the chaos.