Do You Have the Revenue Cycle Basics Covered for 2019?
Financial challenges again ranked as the top concern for hospital CEOs in the most recent ACHE survey of hospital leaders. Medicaid reimbursement (including adequacy and timeliness of payments) was a top concern of 71 percent of hospital CEOs.
Other revenue cycle related concerns identified by hospital CEOs were bad debt (including uncollectable Emergency Department and other charges) (54 percent), Medicare reimbursement (42 percent), and overall revenue cycle management (converting charges to cash) (37 percent).
The hospital revenue cycle encompasses every patient touch point from appointments to payments and back again, and focuses on the reimbursement Holy Trinity of accuracy, timeliness, and compliance.
Follow these tips for getting back to the RCM basics to set your health system up for success in 2019:
Scheduling & Registration
The revenue cycle is all about details, and it starts from the very first contact with a new or returning patient. Ensure your front-line staff is accurately recording up-to-date patient insurance information, contact information, and billing information as necessary.
Efficient front-end processes can lead to major cost and time savings on the back-end of the revenue cycle by detecting and preventing eligibility and insurance coverage issues. Communicating anticipated costs of care before an appointment is another diligent step providers can take at the front end of the revenue cycle to help patients understand their insurance coverage and self-pay responsibilities.
2019 Pro Tip: Shore up your front-end revenue cycle processes with advanced tools and training.
Billing & Collections
Billing and coding accuracy begins with clinicians and medical billing specialists, but there are many steps the patient finance department can take to encourage prompt and full out-of-pocket patient payments.
We already mentioned pre-service cost estimations as a strategy to warm patients to their financial obligations and prevent surprise medical bills. Other strategies to boost self-pay collections include:
- Offering secure point-of-service payment collection technology
- Offering payment plan enrollment at the point-of-service
- Making patients aware of financial assistance programs, if necessary
- Providing step-by-step instructions for setting up online portals to pay bills online
- Making printed medical bills stand out with clear calls to action, colors, and images that steer patients in the right direction and are tailored to their payment preferences
- Deploying advanced analytics solutions to better understand patient behaviors, preferences, demographics, and predicted outcomes to more effectively communicate with patients and avoid bad debt.
2019 Pro Tip: Consider holistic technology that can ease time and resource constraints to solve front- and back-end revenue cycle challenges.
Claims denials are a significant source of financial and resource waste in U.S. hospitals. Some estimates state that payers initially deny up to one in four claims. Revenue cycle leaders will continue to face these challenges in 2019 as they look for the right combination of resourcing and workflow efficiencies.
While staff training can go a long way toward reducing coding and billing errors, technology implementations can take your organization to the next level of revenue cycle efficiency by automating coding and insurance verification, improving point-of-service collections, tracking claims and reducing denials, and identifying trends in payment and denial patterns.
Also, look for opportunities for revenue cycle leaders to work with case management leaders to streamline utilization management — ensuring payers receive the clinical information they need to approve payments.
2019 Pro Tip: Up your game with advanced denial analytics so you can respond faster and prevent future denials.
Payment Posting & Reconciliation
While the front end of the revenue cycle holds many low-hanging opportunities for revenue cycle efficiencies, the back end is ripe for significant workflow enhancements to facilitate payment processing and claims reimbursements.
Efficient payment processing technology can strengthen cash flows and minimize collections risks. An integrated merchant services offering marries front-end collection efficiencies with back-end funding, payment posting, automated reconciliation, and more to improve visibility into the entire payment process.
2019 Pro Tip: Familiarize yourself with your current merchant services agreements and when they expire so you can plan for changes.
Lack of proper training is the root cause of many data errors and inconsistencies in the revenue cycle. Consider filling these gaps by investing in staff training programs in 2019. Host workshops or invest in online training programs, including:
- Patient scheduling and registration best practices
- Coding and medical billing training
- New developments in claims management
- Payer-specific workshops
Many claim denials can be avoided with proper up-front training and consistent processes.
2019 Pro Tip: Stress the importance of data integrity across the board and consider incentivizing employees for completing tasks that play a role in improving collections and revenue cycle efficiencies.
Finally, take time to review and your financial policies and distribute copies to all employees so everyone understands the rules, processes, and expectations for the New Year.
This article was originally published on RevSpring and is republished here with permission.