4 Revenue Cycle Management, Claims Reimbursement Strategies

February 10, 2016 - Organized claims processing and accurate payment help maintain strong revenue cycle management. 

But keeping track of claims reimbursement processes and operations involves a great deal of seemingly convoluted steps. 

The life cycle of a medical claim involves many non-linear interactions from beginning to end. 

When payment is collected from patients matters. The general rule of thumb from healthcare providers appears to be the earlier, the better.

The general manner in which a billing office operates determines revenue results.

Proactive management may be more efficient than a reactive approach to billing management.

The reduction of reimbursement as the healthcare industry moves into a value-based payment realm means often going back to the drawing board to reconsider new financial priorities. 

And making sure patients are clear about how much is owed and when is imperative. A little confusion may go a long way.

Ensuring accurate and timely payment demands the execution of several strategies. 

Here are a few to consider:

Increase up-front cash collection

The elimination of bad debt is directly tied to point-of-service.

Ninety percent of physician practices consider collecting from a patient before he or she walks away as critical to revenue cycle success, according to a study from Availity.

“The biggest challenge for us is to move conversations (with prospective patients) as far up in the process as possible,” Andy Scianimanico, Vice President for Revenue Cycle at Northwestern Memorial HealthCare, told Chicago Tribune.

“It’s not about strong-arming patients to pay. It’s about getting information into the hands of patients so they can make better-informed decisions.”

Keeping healthcare consumers financially engaged is especially important as high deductibles grow higher and out-of-pocket costs increase.

Out-of-pocket copayments, coinsurance costs, and deductible expenses approach $345 billion, estimated PwC’s Health Research Institute. 

Aim for coding compliance and accuracy

A standard billing office operates reactively, instead of proactively, said Monte Sandler, Executive Vice President of NextGen RCM Services, to RevCycleIntelligence.com.

This has to change, he asserted.

“Providers are providing care, documenting their services, and coding. A billing office is getting charges entered and bills out the door. Then, they basically wait until they get responses from clearinghouses or payers in the form of rejections and denials. Then, they react to those.”

This inefficient process delays the payment cycle and makes receiving payment more difficult, he stated.

“I’m a big proponent of flipping that whole cycle upside down to build a much more proactive revenue cycle,” he explained. “Every practice should know if a patient is eligible before the doctor sees the patient.”

“Plenty of tools allow you to check eligibility two or three days prior to a patient even coming in. It’s solvable if the right checks and balances are in place.”

Connect the supply chain dots

Ensure accurate reimbursement by keeping track of high-cost items as they migrate through the healthcare supply chain.

"This is an exciting time for healthcare supply chain management,” stated Tony Vahedian, Cardinal Health’s General Manager of Medical Services and Solutions, within a press release.

"We're seeing executives take action to improve and demand more value from their supply chain," he said.

“They recognize that maintaining status quo in their systems is no longer sufficient due to the ever-increasing cost pressures in the industry."

“With reimbursement being reduced and going to fee-for-value, supply chain is becoming more of an important arena for the C-suite because there's so much cost in the supply chain,” Vahedian told RevCycleIntelligence.com.

Supply chain management is becoming a much greater strategic asset for healthcare providers, he said.

“Whether it's to take cost out, whether it's improved quality of care, whether it's to support the expansion of many of these large IDMs, whether it's standardized products or workflows, supply chain is becoming more relevant.”

“It will continue to become more relevant as the entire healthcare system goes through the reimbursement changes and then the pressure on the cost side.”

Promote public pricing transparency

Clearly informing patients about out-of-pocket costs before services are received ensures more accurate and timely payments, according to research from TransUnion Healthcare.

Three-quarters of over 700 surveyed patients confirmed they can more easily pay their bill with a front-end estimate.

“Now, more than ever, it is critical that providers capture all reimbursements owed to them, given the impending changes to reimbursement structures under the Affordable Care Act and the introduction of healthcare exchanges,” explained John Woody, Transunion’s Vice President of Product Development.

“The fact that patients are not always well-positioned to understand the trade-offs and costs of every medical decisions is precisely why it is so important for the clinicians who decide what goes on the bill to know how they are impacting the patient’s wallet,” stated Neel Shah, MD, Executive Director of Costs of Care.

“After all, if you bankrupt your patient — particularly with tests that are not needed — you are not helping them.”