#revenue cycle optimization

Self Pay Management-Taking the Next Steps Toward Revenue Cycle Optimization

 As practices face shrinking reimbursements and increasing costs, there has been a lot of discussion about the need for efficiency in the revenue cycle. Frequently offered ideas include automating key business processes, tightening physician documentation and enhancing payer relationships. Although these are all valuable suggestions, there are a few lesser known strategies for revenue cycle optimization that practices should consider.   

 Get Control over Self Pay

While practices are focused on growing payer reimbursement by seeing more patients, many overlook the patient portion of the healthcare bill, waiting until the insurance company sends its payment before reaching out to the patient about his or her responsibility. This approach increases the workload of internal collections staff—the area of your practice that receives all unresolved accounts. These individuals are typically overwhelmed working a variety of issues and getting a self-pay account addressed quickly may not happen. Additionally, patients aren’t as motivated to pay their bill if the service has already been rendered. If the bill is sent to an external collections agency, the cost to collect goes up further, as practices can pay between 12-30 percent on any collected dollars.

 Requesting self-pay payments at the point of care lessens the costs associated with obtaining them. Using an automated tool that estimates the patient portion of a healthcare bill can help practices move patient payment upfront. Historically practices were hesitant to use software that estimates patient allowables due to inherent inaccuracies.  More recently however, these programs have become easier to set up and the accuracy has increased significantly.  Such software programs look at allowables and reimbursement amounts based on a practice’s contracts and generate a realistic estimate of what the patient will owe. With the insurance information in hand, information can be entered into the program in advance of this visit, making the patient responsibility readily available when the patient arrives.

 Circle Back and Update the Claims Scrubber

A common recommendation for boosting performance is to use a claims scrubber to identify missing data or inappropriate codes and missing modifiers before a claim is sent to the payer. This allows a practice to fix common issues prior to claim submission, sometimes resulting in cash back within 14-28 days.

 While many practices have implemented claim scrubber and correct claim edits one-by-one.  They do not, however, look for trends in both claim scrubber edits and denials which, if corrected at the root cause, would save the work associated with working claim scrubber edits and denials.  An additional benefit is increased cash flow and payments being received sooner.  This is more cost effective than waiting until the claim gets denied to address the issue. It can cost a practice as much as 3-5 times more to resolve a denied claim as it does to get the claim clean up front. Being proactive is especially important for large volume practices where eliminating multiple denials by shifting corrections earlier can translate into significant savings.

 Get Creative

The ideas outlined here go beyond the typical revenue cycle improvement strategies and they can help practices take that next step toward optimization. It’s important to think outside the box when considering ways to streamline revenue cycle operations. By keeping your work flow as nimble and cost effective as possible, you can widen narrowing margins and lay the groundwork for future growth.


Progressive Approaches to Revenue Cycle Optimization

Sharing best practices, lessons learned and innovative solutions to improve the effectiveness and efficiency of a revenue cycle operation is central to any consulting firm’s success. As part our approach to introducing our firm’s capabilities and experience, I wanted to share examples of how we have helped hospitals, integrated delivery networks, academic medical centers and group practices solve challenges faced by the multitude of regulatory changes, ICD-10, shifting reimbursement models and healthcare reform. Additionally, these solutions have included leveraging leading edge IT vendors to enhance the patient experience while improving revenue cycle performance. Progressive healthcare organizations are taking a strategic view at addressing these seemingly endless pressures by transforming overall patient access and revenue cycle operations as opposed to tackling each pressure as an individual project.

Examples of how progressive healthcare organizations have transformed patient access and revenue cycle operations include:

Evaluating Benefits of A Core Vendor to Support Patient Access, EHR and Revenue Cycle Requirements: A core vendor to meet enterprise-wide registration, scheduling, EHR and billing requirements can provide a variety of benefits including reduced annual operating expenses, clinical work flow efficiencies, improved physician productivity and satisfaction, reductions in lost charges, improved coding and compliance, and enhanced patient satisfaction. However, vendors differ in their features and functionality, as well as their Total Cost of Ownership. Meaningful Use financial incentives have directed attention and resources towards Electronic Health Records, however future state requirements provide an optimal opportunity to evaluate the benefits and trade-offs of vendor capabilities to address an organization’s future state revenue cycle requirements.

Leveraging ICD-10 Conversion to Improve Coding and Clinical Documentation: Converting to ICD-10 will require upgrades to clinical and revenue cycle systems, as well as a significant investment in training physicians, administrative and billing staff. While most organizations have completed or are in the process of completing an ICD-10 impact assessment, ICD-10 planning should include a holistic view of improving charge capture, documentation and billing workflows. As with new revenue cycle system implementations, this conversion provides a unique opportunity for re-designing processes, policies and procedures and your use of technology to drive revenue cycle efficiencies.

Centralizing & Standardizing Patient Access: Establishing a centralized patient access unit to support registration and scheduling for hospital and professional services. Centralized patient access has been an effective vehicle for improving data capture to reduce denials, and also for improving the patient experience by reducing the number of phone calls to schedule services. Frequently, this type of implementation involves consolidating and standardizing Visit Types to improve physician productivity and enterprise-wide reporting.

Single Consolidated Patient Statement: Accountable Care Organizations will tightly align professional and hospital billing operations and require revenue cycle systems to support bundled payments. When addressing these requirements, several of our clients have leveraged this opportunity to implement a single consolidated patient statement covering both hospital and professional services. In addition to significant cost efficiencies, this has a major impact on patient satisfaction which has proven to accelerate patient payments.

Business Intelligence & Population Management: The use of metrics and benchmarking is not new, however advances in healthcare business and clinical intelligence tools provides the ability to leverage actionable information to improve financial and clinical performance. These tools help maximize reimbursement and allow healthcare organizations to effectively and proactively manage patient populations, while complying with payer and regulatory requirements.

Leverage Epic to Optimize Revenue Cycle

 Revenue cycle optimization is a common area of interest for our Epic clients looking to leverage advanced Epic functionality to improve workflows, productivity and ultimately financial performance.
 Culbert Healthcare Solution’s approach for Epic Revenue Cycle Optimization includes a holistic review of the entire patient experience beginning with patient access and flowing through the clinical encounter and the downstream billing and A/R management processes. Based on our experience, common goals for revenue cycle optimization include:


  • Improving patient access, particularly access to specialist services,
  • Enhancing the patient experience,
  • Maximizing physician and resource productivity,
  • Eliminating delays in charge triggering and claim lag,
  • Improved clean claims,
  • Ensuring appropriate and thorough coding to bill for all services rendered, and to reduce billing errors and compliance risks,
  • Reducing payment lag, particularly for Self Pay balances,
  • Improve consistency in reporting throughout the enterprise.

For complex healthcare organizations, common areas for improving their use of Epic to improve revenue cycle performance can often be derived from:

  1. Visit Type setup (consolidation and standardization)
  1. Evaluation of EpicCare charge triggering infrastructure (OPC or Navigators for Charge Capture)
  1. Optimizing advanced Epic tools including Preference Lists, SmartSets, Order Panels, Order Transmittal and Results Routing
  1. Charge Router setup and Error Pool management
  1. Resolute Work Queue setup and structure
  1. Physician / Clinic Engagement, Education and Change Management