One of the major focuses of the healthcare service providers undoubtedly is profit maximization and the ideal way to achieve this is through revenue management which can be accomplished by practicing few simple but very important steps. This essential aspect of the healthcare organization is the key role of the practice managers, who by applying their keen know-how of the healthcare sector and the insurance scenario ensure that the revenue earned by the healthcare organization at the end is in tandem with the profit expectations of the healthcare organization. This in turn reflects upon the economic expansion of the organization. This whole process calls for an in depth analysis of all the possible intricacies of revenue generation and the possible complications too.
Thus, for a practice manager to be successful at his work the attributes like analytical bent of mind, capability of thinking multi-pronged resolutions for problems, giving enough stress on the detailing, etc. becomes prudent. Below are some of the steps that can prove fruitful to the practice managers in their revenue management job.
1. Understand the contracts: The first and foremost point is to understand that the revenue management cycle starts right from the moment you enter into any kind of contract with an insurance company. Hence, any questions pertaining to the contract like the terms and conditions of the reimbursement, rates offered under different circumstances need to be thoroughly probed before signing any contract. The knowledge of these nuances comes in handy for negotiating with the payers on the contractual allowances and the reimbursement. Understanding the terms of the contract well at this stage safeguards you against the possible pitfalls.
However, this should be realistically done while keeping the prerogative in mind. For example, being a solo practitioner would need to negotiate differently than a group of doctors that run a clinic or hospital. One simple tip to make this seemingly complex procedure simple is to reduce the reimbursement on the visits in case you stand a chance of higher returns on any surgical procedures.
2. Stay in touch with the Law: The legal system of every state has some set guidelines for such interactions involving reimbursement to protect the rights of the claiming party. For example the response period for the insurance company to clear out a clean claim is usually 30 days in case of electronic application and 45 days for the paper ones. Such legal awareness is beneficial for the sorting of claims. The unpaid ones should be followed up regularly depending on the amount and older patients. This way no claims will stay unattended and the accounts receivables age will be lesser than 30 days.
3. Identify reason for claims denials: There are quite a few people involved in the billing process. The staff should be able to spot errors in a rejected or denied claim, promptly rectify the error and send it across for re-billing.
Recording the denial report will help to work on the medical billing process as reference to gauge the bottlenecks and streamline the revenue cycle too. This will help to identify the areas that need attention. For resubmissions, every carrier has unique expectations which are a must to know before you actually resubmit.
4. Pay attention to any processing errors: Some of the common errors committed by the payers while processing the claims are skipping a procedure or clubbing two or more procedures together. This results in payment for only one procedure code against more number of services rendered by the doctors in actual. An improper fee schedule may be used to base the payment of the claim. The practice manager or concerned staff should look into such stages of the billing process and carefully review it to keep such mistakes at bay.
5. Don’t panic: In case of an erroneous payment of a claim, appeal for a correction. If your due from the payer fails to reach you for some reason, the practice manager should be aware of the State Insurance Commissioner’s office as the last resort to turn to for resolution.
The above enlisted steps of revenue management in a medical billing cycle are sure shot ways to profit maximization and MedicalBillersandCoders.com is one such place where you can be assured of all these being taken care of adequately to soothe all your monetary anxieties.