Revealed: The Secrets to a Great Revenue Cycle Strategy, Part 2

Welcome to the 2nd installment of our 3 part series as we examine the key components to a great revenue cycle strategy. We learned in part 1 that there are no secrets to revenue cycle strategy. Instead, there are basic principles that, when properly followed either by your billing staff or your Revenue Cycle Management (RCM) services provider, will enable you to get better medical revenue cycle results.

The first three operational principles: Collect patient balances the same day of service Verify patient insurance eligibility Implement a triple clean claims scrubbing process (click here to review those principles in detail) The next three operational principles: Remind Patients of Appointments. No-shows are a very costly component of any practice. According to the MGMA, most medical practices average a 5-7% no-show rate. While there are many strategies for managing no-shows, including no-show penalties, overbooking and collecting advance deposits for some specialties to name a few, the best strategy is a tailored and consistent automated appointment reminder program. Place someone at your practice in charge of measuring the effectiveness of automated appointment reminders based on timing and frequency. I’d also encourage you to request confirmation from your patients for appointments and track this. Population Health and Patient Portal are two effective systems utilized by our firm. Tracking and Preventing Claim Denials. Finding why your claims are getting denied, ranking them by denial code and payer, and then systematically fixing them at the source can dramatically impact both practice cash flow and operational efficiency. As is often the case, you will likely find that 20% of the denial codes account for 80% of your denials. Most claims clearinghouse solutions have this information readily available and it is just a matter of assigning the tracking and fixing of denials to a team member. Often denials result from something as simple as an incorrect referring provider number or provider linkage errors up to more complicated improper use of modifiers, etc. No matter the reason, most denials can be fixed, often by examining why they occur and fixing them at the source of your front-end processing. Clean claims rates should be in the 94-98% range. Manage Insurance Underpayments. Loading fee schedules and producing a regular under/overpayment report will be very beneficial in identifying any insurance underpayments and making the necessary adjustments. Setting up access to payer websites will help you gain access to these fee schedules which can often be imported by your PM System. Also producing reports which identify any time you receive payment of 100% of a payer’s allowed amount will be helpful in identifying where your fee schedule may need a bit of tweaking. Measuring these vital operational components and then implementing an ongoing strategy toward their optimization can pay substantial dividends in today’s challenging world of increased provider demands and shrinking reimbursement. Check back with us soon where we complete this series with a look at the final components of optimizing your revenue cycle management.

David Dyer Vice President of RCM Group Services and Business Development

Revealed: The Secrets to a Great Revenue Cycle Strategy, Part 1

As in all businesses, there are many challenges to effectively delivering services; Revenue Cycle Management services are no different.  Revenue Cycle Management (RCM) includes everything from verifying patient eligibility and up-front payment collection to coding, claims processing and tracking, and payment posting. There are no secrets to revenue cycle strategy, only basic principles that, when properly followed either by your billing staff or your RCM services provider, will enable you to get better medical revenue cycle results.  This will be the first in a multi-part series which will examine these principles. 

1. Collect Patient Balances the Same Day of Service. 
    
   All specialties are unique, and each requires its own tailoring, yet the fact remains that the best receivables strategy is not to have any.  Colleting co-pays, patient balances, upfront payment plans, etc., at the time of service (or at least as much as possible), minimizes what many practices have difficulty collecting afterward.  Collect up front.  Most businesses do.
    
2. Verify Patient Insurance Eligibility.
    
   Even some of the most advanced practices are not using this function.  Because we are a provider of services based on collections, much of which comes from insurance companies, it is important for us that we have our clients verify patient eligibility whenever possible. This can be done either before their scheduled visit or at check-in.  Follow up efforts (and costly staff resources) greatly increase when a patient’s insurance eligibility is not verified at the time of service.  
    
3. Implement a Triple Clean Claims Scrubbing
    
   Just like quality control on a factory assembly line, it is more productive to build your claims properly the first time.  The most effective claims scrubbing involves multiple review processes, often as follows:

1. The first scrub is performed manually by charge entry staff with comprehensive coding knowledge. The team looks at the claim to make sure proper codes are being used, the proper procedures have been ordered, and that the proper modifiers have been included, if necessary. This should be done prior to electronically submitting claims to the clearinghouse.
2. The second scrub is performed by your Enterprise Practice Management (EPM) software.  The strongest EPM software solutions can check your claims against the similar practices in the healthcare community for potential errors before the claims are electronically submitted to the clearinghouse.  As more and more edits are accumulated, clean claim rates should continue to improve.  Any errors from this scrub should then be manually reviewed.
3. The third scrub is performed at the clearinghouse level where claims can be cleaned up post-submission but before reaching their final destination with the payer. As with the second scrub, any errors should be manually reviewed.
    
   Implementation of these revenue cycle management principles should be followed up by inspection to ensure that they are being done properly.  The investment in time taken to make sure these processes are properly in place are well worth it.
    
   Check back soon when we pick this back up with a look at proper claims denial management processes.  

David Dyer

Vice President of