The revenue cycle is defined as all administrative and clinical functions that contribute to capturing, managing and collecting revenue for services rendered. In simplistic and basic terms, it’s receiving money for all rendered services from insurance companies and patients. Revenue cycle functions include charges capturing, patient demographics entry, medical coding, claim submission, payment posting, rejections handling, denial resolutions, accounts receivable management, and reporting. A healthy revenue cycle should follow billing and collection best practices to ensure bills are submitted in accordance with payer requirements. The last thing that a healthcare organization needs are to provide services and not be paid. In this article, we shared tips on improving revenue cycle functions which will help to reduce inefficiencies in the billing process and helping you to collect more.
Daily claim submission: Staying current and submitting new claims each day is best practice to ensure days in AR are accurate and allows the appropriate amount of time to identify any mistakes that may be occurring prior to claims submission. If you submit claims late, you will receive reimbursement late, as simple as that.
Work edits daily: Review and edit submitted claims daily and look for rejected, denied, or scrubbed claims on a daily basis. Failure to identify coding or charge entry mistakes prior to claims submission can result in claims being rejected by the payer. Establishing an internal process to work through edits and correct claims will decrease denial rates and produce healthy cash flow.
Try to maintain dedicated staff: This is easier said than done. Your experienced resource should handle the claim edit part as he knows common claim submission mistakes and their resolutions. A person who is very familiar with edits can resolve them quickly and recognize patterns that may indicate larger trends and issues.
Automate as much as possible: 90% of payment posting should be automated to minimize errors. Most billing software provides an auto-post feature where payments are posted as per EOBs and ERAs as per line items. Accurate payment posting is critical to overall profitability as well as ensuring patients are billed for the correct amounts. Accurately capturing denial reasons helps identify the root cause.
Read every line denial: Payment posting consists of not only posting payments but also involves posting adjustments and denials. Sometimes payer may deny a complete claim or just one line item on that claim, it’s important to have high attention to detail.
Focus on adding secondary and tertiary payers: Most billing systems will submit secondary claims electronically unless there are edits within the systems. At the time of entering the patient’s insurance information, input details of all insurances and assign them as primary, secondary, and tertiary. If the primary payment is posted with errors the secondary claim may go to the payer with mistakes.
To maximize time spent, hire talented and dedicated specialists who are trained to follow up with insurers and have the ability to thoroughly understand claims from denial to payment. This role diligently follows up with claims that are processed incorrectly or not yet processed. I would be surprised to know that a whopping 20 percent of medical claims are processed incorrectly. That’s 1 in every 5, which can significantly damage cash flow.
Track submitted claims: Ensure claim report data is properly interpreted and denied claims are separated into ones that are preventable and ones that need to be managed when they occur. Track denied claims for missing information, root cause analysis is necessary to determine how information gets missed.
Categorize denials: The denial may indicate a missing preauthorization/referral but looking into the specific payer details will help determine if your front-end staff failed to obtain the authorization or if the inaccurate information was specific to what that payer needed from the authorization when it was obtained.
Be proactive: Work on credits and issue refunds to patients and insurance companies regularly. This approach will help you to prevent credits from becoming unmanageable and it won’t negatively twist performance data.
Decide deadlines for refunds: If refunds are sitting for more than two months, you will most likely find yourself with unhappy and confused patients. Delays in refunds will lead to miscommunication and ultimately creates a sense of mistrust among your patients.
Having a team that can efficiently handle revenue cycle functions is really crucial as it decides the financial sustainability of your healthcare organization. Functions in the revenue cycle are critical to the success of your organization, and outsourcing these functions with a medical billing company has many benefits. Our medical billing and coding services will resolve any difficulty with recruiting, retaining, and educating qualified staff members. To know more about our coding and billing services please contact us at firstname.lastname@example.org / 888-357-3226