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.
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.