Are you optimizing technology and ensuring your revenue cycle is efficient? With rising costs and decreasing revenues, automation is no longer an option. Advantages to automation include; decreasing manual and duplicative work, decreasing cost, improving data collection, improving cash flow, decreasing claim rejections and increasing cost savings. Some areas to review are as follows:
Confirming patient’s eligibility before every visit is no longer optional. Practice Management systems can automate and “batch” this feature; some can “run” the eligibility the same day, but prior to opening the office. Consider how far in advance of the visit this information is required and if more than one attempt is needed. If new patients are scheduled in less than a week, set the eligibility feature to activate during this time frame. By running the eligibility feature overnight but the same day as the visit, employees can prioritize their work and focus on the patients scheduled the same day.
Utilize insurance and other websites to confirm if valid referrals are available for upcoming scheduled visits. Train staff to confirm if the referral is on file, from the PCP of record and the correct date range. Create a central repository of the guidelines by payer. This prevents one staff person having all of the knowledge. Identify a uniformed location in the registration screen to add instructions for check in staff; such as “inform patient referrals expire on xx date or scan insurance card or annual paperwork required.”
Claims Submission using electronic remission (ERA) and posting via electronic fund transfer (EFT) are common in today’s billing office. Daily processing ensures the practice is submitting to payers regularly. This creates a smooth and continuous flow of payments in the practice. Electronic fund transfers are reduce effort to process the payment and decrease the time the days in A/R thus improving the metrics of the practice. The lockbox is another tool to reduce manual payment posting. Ensure payments are being deposited into the lockbox rather than being sent to the office.
With health plans using their own software to identify potential denials to the practice, practices need to look for opportunities to circumvent denials. Practice Management systems and aftermarket products can have “rules based language” added as an overlay to the billing system and reduce or eliminate potential denials which need to be re-worked, resubmitted or revised. The claim submission process can include a clearinghouse with a “scrubber” to clean the claims and further eliminate potential errors such as coding, demographics, missing referral, incorrect eligibility. Denial summaries can be developed into a scorecard for staff and performance can be documented at the department and individual level.
Secure messaging between specialists and primary care physicians is a built in feature in many electronic health records. This feature allows the transmission of patient information in a secure and immediate manner. Secure messaging makes it easier for primary care physician and specialists to communicate clinical information and can enhance the referral process. Secure messaging can reduce and/or eliminates the manual work involved in printing, copying and scanning and allows both practices to receive credit for the meaningful use transition of care measure.
Patient Portals are a tool to meet the patient engagement measure for Meaningful Use Stage 1 and 2 and enhance the relationship with patients. Portals can be expanded to allow patients to ask questions about their care, download information about their visit and/or diagnosis, pay their bill, ask a question, and/or request a refill. This feature can reduce no shows in your practice, and allow patient needs to be met, without a face to face contact. Practices should have defined rules and workflows to ensure that patients with acute or chronic conditions receive the appropriate amount of face to face care at recommended intervals.
Reporting for Meaningful Use and PQRS will be required to negate revenue reductions. There are several methods including the GPRO, Registry and Individual reporting for PQRS. Regardless of your metrics or specialty, it will be essential to have decision support tools and data extraction capability. Speak with your EMR vendor to be sure you have this capability and know how to use it.
Use of telephonic Call confirmation is another meaningful use measure. Electronic call confirmation provides a record of the response of the patient when the call was received and/or numbers which were incorrect. The program typically has an automatic dialer allowing several outreaches to the patient. With the cost being as low as .10 cents, it is no longer effective to employ a staff member for this function.
The passive act of sending a statement does not always translate to a paid bill in the high deductible patient environment created by cost sharing models. Many patients do not understand how their plans work and the amount of out of pocket expense which is the first step to a paid claim. Go green! Consider the use of Estatements and/or possibly outsourced statements. Reinvest the savings into hiring billing staff to reach out to patients, set up payment plans, explain their bill and associated deductibles and coinsurances and be a resource to the staff.
On line bill pay and secure storing of credit card numbers; go hand in hand with time of service estimates. Be ready to provide patients with their expected patient responsibility when asked. Utilize tools such as “credit card” on file to save the credit card numbers in a secure manner and set them to automate payment to the practice. On-line bill pay is a “no brainer’ as it allows patient to pay for their services 24 hours a day 365 days a year and reduces manual efforts of your staff.
Automation is a key component of a patient centered; cost effective and healthy revenue cycle. Assess the potential opportunities in your practice.