For clinicians working in the complex American healthcare system, getting paid for every single procedure, service and visit has always been something of a challenge. Yes, fee-for-service medicine created a fairly linear relationship between effort and remuneration, but even in that scenario many hospitals and practices have teetered on the edge of solvency, in part for lack of efficient billing practices.
Indeed, in a poll conducted last year by Cardinal Health, decision makers said reimbursement is the number one problem facing health systems today.
Now healthcare is moving toward a quality-based payment model that equates compensation with value, leaving fee-for-service in the rear view. Especially for organizations that struggled to bill comprehensively before, what might be the impact of this change now?
The truth is, we don’t yet know. As Carrie Pallardy writes in Becker’s Hospital CFO, “What healthcare revenue cycle management will look like once the value equation is finally deciphered remains to be seen.”
Still, the same practices and principles that applied to fee-for-service revenue cycle management will endure moving forward, even if they become doubly important. If you effectively bill now, you will be better prepared for future dynamic changes to the system.
10 basic revenue cycle best practices
- Scheduling is the first line of defense and accurate demographics and insurance information are essential. Confirm that the patient has coverage and understands co-pays are expected at the time of service. Identify self-pay patients and make them aware of the payment policy.
- Attempt to collect outstanding patient balances when speaking with the patient on the phone, or make sure they are aware that payment will be expected the next time they visit.
- Designate a pre-certification and authorization lead staff member to obtain approvals for diagnostic testing or procedures to avoid denials and thereby loss of revenue.
- Ensure accurate and comprehensive medical records to document billable services. From an insurance standpoint, if it’s not documented, it didn’t happen. EHRs, now commonplace amongst physician practices, help tremendously by lowering the duplicate patient record rate, which the Healthcare Financial Management Association says improves the accuracy of information.
- Verify the capture of all billable charges, confirm that they are coded to the highest specificity, and bill patients in a timely manner.
- Correct claim errors that create denials quickly and efficiently; even better, designate a staff member responsible for this task. If recurrent errors become a trend with a particular provider or staff member, make sure they are aware of the correct process or procedure.
- Post payments in a timely manner to hasten the revenue cycle process. Use electronic remittances as often as possible and establish a threshold for small balances that are automatically written off.
- Audit insurance follow-up reports to maximize reimbursement. Insurance companies have different timely filing restrictions; auditing this report will help avoid financial losses.
- Monitor accounts receivable on a regular basis. Assign a staff member to review reports and establish benchmarks for the collection process.
- Send patient statements on a pre-determined regular schedule.
What you probably noticed is that the keystone of revenue cycle management success is effective communication. The frontline staff has to be gentle and caring, yet persistent, resilient and unyielding. Do you already have people on staff with strong personalities and the ability to communicate effectively without being abrasive? Build many of these best practices around those people and chances are good your revenue scenario will improve.
Mordy Pelleg is the founder and president of Medsphere's MBS/Net division, a proven provider of essential tools and services necessary to effectively manage physician practices.