Healthcare organizations of any size need to assess the sustainability of their revenue cycle. Government regulations, such as the Medicare Access and CHIP Reauthorization Act have put more of a focus on value-based care, which creates a need for documentation improvements, process optimizations and increased transparency.
Here are ways to improve your revenue cycle:
1. Use integrated technology to remove departmental silos
The revenue cycle impacts and is impacted by every department within the organization. Everyone is a stakeholder in its success, from the CFO to individual physicians. Siloed departments hinder success because they limit the free movement of data within the organization. When the billing department cannot effectively communicate with physicians, for example, it can take a long time to correct coding errors, which involves yet another department.
Integrated technology supports transparency and makes it easier for everyone to work effectively. When mistakes are made in the billing process, for instance, there’s a limited amount of time to make corrections before the risk of RAC audits increases to unsustainable levels.
Even if an organization has world-class billing software and top-tier charting solutions, it means nothing if those applications cannot easily share data. Integrated solutions give all stakeholders the ability to communicate more easily and solve problems in real time. This increased agility makes it easier to respond to issues as they arise.
2. Focus on denials management
As payor requirements change, denials management becomes an area of greater focus for organizations of any size. Healthcare IT News, citing information from The Advisory Board, reported that claims denials result in a 3 percent loss of net revenue, on average. If you consider that it costs roughly $25 to rework just one claim, the total cost of denials stacks up quickly.
The majority of claims denials are recoverable, but wouldn’t it be better to avoid them in the first place? Of course, insurance companies do not always make that easy. In fact, they’re often hesitant to share denials data with organizations because doing so could decrease their ability to compete in the marketplace. Therefore, it’s up to denials managers to step up their own efforts.
“Denials can result in a 3% loss in net revenue.”
Improving inter-departmental transparency is just one way to improve denial rates. RevCycle Intelligence reported denials key performance indicators can be improved by using business intelligence analytics tools. When you have robust, accurate reports, your organization can identify trends and target improvement efforts where they’re most needed.
For example, your KPI data may indicate that claims denials stem from the coding department. In that case, managers could enact new training procedures for coders. For more granular improvements, organizations may want to consider creating separate KPIs for each payor, as each may have its own unique requirements.
3. Automate accounts receivable functions
The other side of denials management is accounts receivable, and it can be improved by automating certain functions. For example, account prioritization is highly important because it allows you to focus resources where they will make the most impact. Investing in custom solutions to automate prioritization could protect an organization’s revenue cycle by ensuring larger accounts get serviced ahead of lower-priority accounts.
RCM expert Sondra Akrin, speaking to Becker’s Hospital Review, explained that the rise in higher deductible plans has placed more financial responsibility on patients. Therefore, hospitals need to focus more resources on patient-facing collections efforts. Though payments from insurance providers may be worth more, the high volume of patient-responsible claims makes it well worth the effort to realize those payments in an efficient manner.
4. Invest in patient engagement solutions
Patient engagement can improve revenue by reducing the rate of no-shows, lowering the number of unintentional hospital readmissions and accelerating payments. By investing in tailored engagement technology such as appointment reminders, intuitive patient portals and automated satisfaction surveys, hospitals and clinics may be able to realize a more sustainable revenue stream.
Patients respond well to engagement efforts, because the benefits go both ways. A HealthMine survey revealed that roughly two-thirds of patients said an easy-to-use portal improves their understanding of their personal health. Plus, the National Partnership for Women and Families found that 80 percent of patients actually use their provider’s portal, making that technology a worthwhile investment.
To learn more about customized revenue cycle management solutions, contact Tangible Solutions today.