Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

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5 Ways Smaller Providers Maximize Revenue Cycle Management

Hitting revenue cycle management targets demands communication, education, and discussion about where new billing, coding, and automation opportunities lie.

- Revenue cycle management is about breaking through the cash flow ceiling and generating the greatest amount of net revenue possible. But issues of claims denials, coding compliance, where to intelligently cut cost corners, automation hiccups, and a lack of staff and physician training are merely a few challenges healthcare providers juggle.

revenue cycle management healthcare providers

Providers remain focused on how to strengthen their revenue cycle management strategies and approaches. Physician reimbursement has declined because of Medicare and Medicaid. Claims data submission requirements have become more stringent. The significance of making sure billing is completed in an accurate manner has only increased in a post-ICD-10 landscape.

Here are five strategies for smaller providers to help maximize their revenue cycle management, efficiently scrub claims, receive timely and accurate reimbursement, and collaborate effectively as a team.

Pay attention to revenue cycle compliance

The importance of accurate billing is perhaps only heightened as providers pay greater attention to compliance alignment pressure.

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“You have to make sure your practitioners are set up and working appropriately and there's an understanding by both your revenue people and your billing professionals about expectations,” stated George B. Breen, Member of Epstein Becker & Green Firm, to RevCycleIntelligence.com.

Just because something has been done a certain way up until a certain point does not necessarily mean change is to be ignored, he asserted.

“The reality is most people are billing and coding and documenting in a fashion they believe absolutely justifies the bills. It’s another reminder for people to consider that this is an area the government has been looking at for a long time, it's laser focused on these issues.”

“This gives the government another opportunity to examine these issues, which is why it ought to be significant.”

Do not operate in maintenance mode

READ MORE: Patient Financial Responsibility Not Owed Top Medical Debt Issue

Consider moving beyond the concept of maintenance mode to look at the greater revenue cycle picture.

“We will always look at some way to squeeze it a little bit more, get more efficient, reduce cycle time and waste,” said Rick Lyman, the Vice President of the Revenue Cycle at Advocate Health Care, to EHRIntelligence.com.

Lyman's revenue cycle goals are simply about improving current performance levels and net-revenue while maximizing cash flow. Cutting costs must be a priority, he explained.

“It’s improvement on denials, underpayments, and reducing bad debt. Also, we need to be efficient.” 

“We actually believe … if we do a service and do all the things right to bill the account, we’re going to get paid for it. That’s how we help our hospitals.”

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Automate to reduce likelihood of human error

Burdening staff with even the most basic or seemingly redundant memory-based tasks can lead to costly errors and a loss of valuable productivity.

If I charge that I started an 18-gauge IV in the right antecubital, as soon as I charge that in the record, it automatically drops charges for those supplies at point of entry. I don't have to remember it,” stated Jason Fugleberg, RN, BSN, Vice President of Patient Services/Chief Nursing Officer at Millinocket Regional Hospital, to RevCycleIntelligence.com.

“You chart what you do and you get credit for it. You're reducing the rework and increasing your efficiency. There is no memory or human error involved.”

Additionally, the automation of an accounts receivable system can help smooth out revenue cycle wrinkles before they pop up, explained Janice Crocker, MSA, RHIA, CCS, CHP, in Journal of AHIMA.

“The medical practice should establish when in the process the account will be changed from insurance to patient pay in absence of a payment from the third-party payer.”

Many practices, for instance, choose to manually convert to patient pay at 30 or 45 days after a claim is first sent to a third-party payer, she said. This may prove to be a top strategy.

“Sending a statement to the patient at 30 or 45 days can result in the patient working with the insurance company to expedite a resolution to any coverage issues.”

But this is not about a set it and forget it mentality. Relying on manual holds with a collection module, she said, may cause revenue glitches or lead to confusion.

“It is better to explain to the patient that the system will automatically produce statements rather than manually holding any statements and then forgetting about the account.”

Keep track of expenses in, expenses out

“If you’re bringing in a certain amount of revenue, you can’t have expenses that exceed that revenue. It’s seems very basic but people don’t look at it that way,” explained Neerav Jadeja, Administrator at Paradise Valley Hospital, to RevCycleIntelligence.com.

We are always looking to ensure we are reimbursed for the services we provide and to improve our communication with our payers on claims to ensure financial stability and balance our large charitable care contributions.”

Incessant monitoring means charges are not as likely to get lost in the shuffle, reasoned Crocker.

“It is important to work closely with the providers and personnel in the non-office setting to develop a method to capture non-office charges. Hospital computer systems can generate a provider’s surgery schedule, ancillary outpatient schedules, and inpatient census.” 

Build up the expertise level of your staff

The general expertise level of a staff or a group of physicians may not always align with revenue cycle goals. Making sure both are on the same page is another strategy to implement, using communication as a bridge of sorts.

“Providers are stretched in different ways. They have been focused on Meaningful Use, EHR adoption, PQRS, value-based modifiers, ICD-10, and more, from a clinical perspective and a regulatory perspective,” asserted Monte Sandler, Executive Vice President of NextGen RCM Services, to RevCycleIntelligence.com.

“They are reimbursed on a transactional basis and they see as many patients as they can to generate revenue. Their expertise is in patient care and, quite honestly, nobody prepares them for proper coding, proper billing, and collections. It’s always on the back of the list.”

“We see in practices that Sally is managing all the billing because she’s been there the longest. Things get missed and revenue suffers.”

Educating physicians and staff members about the different facets of the revenue cycle will prove financially beneficial for providers, said Crocker.

“A good practice management system that suits the needs of the practice is critical. In addition, having at least two staff members thoroughly trained (including ongoing training when the system is updated) and knowledgeable about the functionality of the system is a must.”

“The staff members can serve as the liaison with system support and provide training to all staff members who need to enter or retrieve data, or generate reports from the system.”

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