A well-organized revenue cycle management is critical to upholding good finances. The healthcare revenue cycle is important to healthcare providers’ capability to uphold physician compensation, reduce overhead, and introduce new technologies. When the healthcare revenue cycle is not managed well, collection drops and accounts receivable (AR) days increase. Many tasks go into the revenue cycle, from eligibility verification, collecting insurance and procedure data to preparing claims to billing patients. When any of RCM processes are inefficient or ineffective, the healthcare revenue cycle is unnecessarily prolonged.
Streamlining the healthcare revenue cycle involves ensuring collection efficiency with observing AR days. With a well-managed revenue cycle, money comes in faster. Everyone plays an important role in RCM, from physicians, nurses, and other clinicians to medical accounting staff to administrative workers.
Increase Collection and Reduce AR days
Make the Healthcare Revenue Cycle More Front-End Driven
By making the healthcare revenue cycle more front-end driven, you can separate administrative work from the clinical setting, often improving the experience for both clinicians and patients. Providers can easily achieve this by outsourcing their medical billing to MedisysData, they can experience increased collection in their practice.
Once a patient is scheduled, a staff member is notified and can begin verifying insurance information and eligibility, requesting pre-authorization, if necessary, and estimating patient liability. Much of this work is done on the back end, but doing it up front, instead, and giving patients the opportunity to pre-pay cuts collection costs and can reduce the risk of patient collection issues. Obtaining pre-authorization up front prevents rejected claims and helps keep AR days under control.
Keep a Robust Plan for Reducing and Handling Rejected Claims
Rejected claims represent a major role in revenue loss. Denials represent the 10 percent to 20 percent of claims that cause most missed revenue collection chances. When denials are allowed to accumulate, opportunities for collection can be missed altogether, and AR days increase. We ensure our billers start looking specifically to claims denial work, so rejected claims can be resubmitted quickly.
Here are a few key steps you can take to reduce hospital AR days.
- Work toward timely, accurate documentation by ensuring timely and accurate documentation for coding and billing cases and adequate revenue cycle staffing, AR days can be reduced. Reviewing transcription turnaround times can find inefficiencies that can be corrected, and having consistent communication with doctors on outstanding dictation can ensure timely completion of this critical process.
- Set “clean claim” goals. Make sure your coders and billers (or billing company) understand your expectations for clean claims. Set a goal of getting clean claims out within 48 hours of receipt of the required documentation. Also, make your goals for follow-up on electronic rejections on uploaded claims crystal clear.
- Manage the claims denial process effectively meeting your goal for days in AR is essential for keeping the healthcare revenue cycle on track.
- Ensure you have processes in place for tracking denials and that your personnel understands how denials are to be handled to minimize time to payment. Communicating the claims denial process as part of your revenue cycle staffing procedures can effectively reduce AR days.
- Educate personnel on payer-specific policies to ensure that your personnel has access to training on requirements for Medicare, Medicaid, and major private insurers. Many payers have online access to policies as well as webinar-style training for this purpose.
As healthcare organizations are dealing with the ever-changing financial landscape, the medical billing and coding operation is one of the most important aspects of managing a healthcare business. Any healthcare organization can reduce their accounts receivable (AR).
Are you in need of trained and certified resources to reduce your AR days cost-effectively? Outsourcing healthcare accounts receivable services to MedisysData can help the organization to effectively reduce AR days.