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Healthcare facilities can cut costs by assessing their revenue cycle for opportunities to optimize processes and workforce. Ensure your technology is optimized and used to the fullest of its capabilities. Improve supply chain, streamline management structures and improve patient throughput.
The stages of the revenue cycle are as follows:
Front End: Patient Access (Insurance Verification, Pre-authorization)
Middle: Service Delivery (CDI, Charge Capture, Coding)
Back End: Receivables Resolution (Claims, AR Follow Up and Denials Management, Collections)
Each stage of the revenue cycle is important and necessary but there are imperative tasks for timely, optimal reimbursement.
- Pre-registration: accurate patient information should be collected, and all prior authorization determinations made. Patient financially cleared for point of service.
- Point of service: collect patient portions for service including copay or self-pay balances
- Claim submission: appropriate codes supplied on patient claim along with all necessary documentation to support
- Claim follow up: any factor could cause the payer to deny the claim. Follow up is important to determine correction or appeal.
- Patient liability collections: providing accurate statements and follow up for collection of payment balances. If it turns to bad debt (generally over 120 days), it is imperative to follow state guidelines and regulations for compliant collections.
Revenue cycle best practices are as follows:
- Put the patient at the center of the process.
- Collect patient responsibility prior to services rendered.
- Ensure you have exhausted the search for coverage for uncompensated care.
- Optimize your chargemaster as it’s foundation for all charges.
- Ensure accurate and appropriate coding.
- File claims in a timely manner.
- Manage/prevent denials.
To cut revenue cycle costs, consider outsourcing business office functions and utilizing global resources when possible. Make sure your technology is optimized and fully utilized to the extent of its capabilities before bolting on.
To evaluate revenue cycle performance, conduct a comprehensive revenue cycle assessment. It can help reduce and prevent denials and ensure that you receive appropriate reimbursement for services. Evaluate to include KPIs, current processes, tools and staffing.
A comprehensive revenue cycle assessment can help identify problems revolving around staff, processes and tools. Know the Key Performance Indicators (KPIs) in areas of accuracy, productivity and reconciliation and make sure you are measuring against them. Rising AR, revenue leakage and high denial rates are general indicators.
There are many platforms based on cost and size of the practice, but before transitioning or adding new technology, always ensure it is necessary and that you have fully optimized your current technology. Often it isn’t the technology that needs updated, but processes and utilization.
Maintain a clean CDM by eliminating outdated and duplicate charges. Ensure all charges are accounted for. Benchmark charges according to your market and adjust shoppable charges to safeguard market share.
Improve revenue cycle KPIs by first assessing the revenue cycle end to end. General best practices:
- focus on the patient and their education
- consolidate and interoperate processes wherever possible
- collect payments early and meet the patient where they are providing multiple ways to pay
Revenue cycle outsourcing is the turning over of revenue cycle processes to another entity and allowing your staff to focus on patient care. Scopes can be targeted, departmental or comprehensive. Resources can be domestic, offshore or a combination which allows for increased productivity and cost savings.
Whether you should outsource your revenue cycle should depend on the goals of your organization. There are also different levels in which you can outsource. However, most will find outsourcing advantageous to financial and operational improvement.
Pros of revenue cycle outsourcing:
- steady resources
- cost savings
- increased revenue
- dedicated staff
- increased efficiency and accuracy
- better focus on patient care
- reduced compliance risk
Cons of revenue cycle outsourcing:
- less ownership of process
- less personal – make sure your vendor acts as an extension of your team
In a revenue cycle services provider you should look for a vendor who:
- Does not subcontract to other vendors.
- Deploys a trained workforce.
- Analyzes processes and offers areas of improvement.
- Focuses on revenue cycle KPIs.
- Provides dedicated, responsive teams.
- Automates processes whenever possible.
- Helps scale your business.
- Collaborates effectively and provides valuable reporting.
Depending on the service area, breadth of scope and data access needs, implementation should take anywhere from 60 to 120 days with value realization following closely behind.