How patients select health plans, choose their health care providers and pay their health care bills is undergoing a dramatic change in the health care delivery system in the U.S. To effectively manage the financial impact of that change, it’s about time that your practice must upgrade their revenue cycle management capabilities.
As small practices grapple with a plethora of issues affecting their ability to collect payments from patients and health insurers having a professional medical billing and coder like Medisys taking care of your revenue cycle can reduce greater difficulties ahead.
Merging front and backend functions, leveraging data, collecting payments upfront, and automating prior authorizations are the primary key factors to revenue cycle management excellence.
New trends, such as value-based reimbursement and healthcare consumerism, also continue to change the way care is paid for and delivered. Organizations must respond to consumer and market demands to keep their doors open.
If you are one of those still struggling between revenue cycle management and core practice; you need to identify what needs change or improvement.
Process The Claims & Billing
When followed by strict adherence, the revenue cycle management system will guarantee results. The procedure involves claims submission, data collection, AR processing, automation, specialist prioritization, etc. Working with information, structure, and discipline is what produces reliable higher performance especially when you have Medisys as your medical billing and coding partner.
Optimize & Fill The Gaps In Existing Revenue Cycle Capabilities
The backbone of any effort to improve healthcare revenue cycle management performance is the ability to leverage technology and services that are both flexible and scalable given the growth in the number and complexity with payers and the increasing need to work directly with patients regarding their financial responsibility.
Clearinghouses are used to electronically transmit claims to third-party payers. Reports generated alerts the practice provider in case if the claims were excluded by the payers.
The denials should be worked immediately; and if the errors were because of the data entry or there are trends in the errors, staff members should be informed about the errors and necessary steps taken to implement processes to avoid similar errors in the future.
Promote Caring Contacts with your Patients
Every person who interacts with patients should have the skills to do their job competently but with a kind demeanor. Make it convenient and pleasant for patients to do business with you. You will receive better responses from patients if processes are simpler. By having scripted questions and responses for staff, you can increase positive outcomes and provide good first impressions for patients.
The reasons for the denials can include incomplete or inaccurate insurance information, lack of pre-certification or prior authorization, not capturing all of the tests or procedures, diagnoses, and procedure coding errors or omissions, past filing limits submission of claims, or denial due to lack of meeting medical necessity. Best practice is to trend and track the denials at the time of posting the payments.
Healthcare practitioners and hospitals should consult with their revenue cycle management vendors like Medisys for tips to success, subject matter expertise, and advice. Medisys is a professional medical billing and coder service provider who knows what’s working with all their clients. Partnering with a vendor and tapping into their real-time knowledge will pay big dividends.