Here are five revenue cycle management tips from industry experts, published by Becker's Hospital Review in November.
1. "In my experience as a revenue cycle manager I've noticed that there is one aspect of the revenue cycle that healthcare organizations overlook — proper handling of patient statements. Patient payments contribute a significant chunk of revenue to a hospital's bottom line. It is about time that hospitals and physician practices change the way they handle patient statements. The first step is to vet out credit balances and identify low or zero balance accounts. Sending our patient statements for account balances that are below $5 is a drain on time and money. Running statements twice a week eliminates heavy backlogs. Consistent follow up with patients is also essential to keep the wheel of progress going forward." - Nancy Lopez, manager of the lost revenue audit program at BillingParadise
2. "A robust patient access strategy is inevitable to thrive in the value-based care environment. To eliminate patient access hurdles, hospitals must focus on automating pre-authorization, payer policy maintenance, benefits verification and securing authorization.
"Lack of centralization in pre-service activity, inconsistent processes, lack of knowledge in payer plans, manual patient data entry challenges in pre-authorization screening and verification are the root causes of claim denials. Nearly 49 percent of denials are due to front-end revenue cycle inefficiencies. Hospitals must automate their patient access processes to optimize their revenue cycle." - Ethan Hawke, regional director of billing and client relations at BillingParadise
3. "Insurance companies possess vast amounts of data and sophisticated modeling tools to give them a tremendous advantage in negotiating rates. Healthcare providers often lack sufficient analytical tools or a full understanding of how a proposed contract might impact revenue — costing practices millions of dollars.
"The bottom line is data offers providers with the competitive advantage and insights to swing the negotiations in their favor. We recommend utilizing the physician practice billing and contract data as well as market intelligence to analyze the proposed payer rates and their effect on a practice's top line. When it comes to rate negotiation, payer contracts are put in context with the rest of the commercial business and Medicare, so consulting with experts familiar with your market will put you at an advantage." - Kyle Kobe, vice president of consulting/analytics services at nThrive
4. "Many healthcare providers have invested significantly in EMR systems, but are frustrated that their systems are not living up to the claims acceptance rates as anticipated. Why not get the most out of your EMR system by embedding claims rules upstream so your errors are resolved faster? It eliminates productivity loss that results from flipping between an EMR and claims systems and streamlines the claims management process that results in increased returns — you get the reimbursement you deserve.
"Boost the power of your EMR system with claims management technology that assures compliance with healthcare rules and edits, and expedites claims quickly and correctly without a huge financial investment. This kind of tool embeds rules upstream and provides you all the information you need in one system to produce clean, accurate claims; the tool will more than pay for itself. One healthcare organization reported that, after adding claims management software to their EMR, they reduced their Medicare accounts receivable days by 13, and increased cash flow by 14 percent in the first year and 7.5 percent in the second year." - Moliehi Weitnauer, vice president of product management and strategy at nThrive
5. "For concurrent denial determinations, the peer-to-peer medical review process often offers the best opportunity to get a case mediated before the overall revenue impact becomes substantial — therefore, maximizing this brief window of opportunity is crucial. With only one shot, an effective peer-to-peer review process requires three things: the right data, the right format and the right approach.
"Despite most organizations' efforts to overturn denials early, the peer-to-peer review process often goes unsupported and can transform into a conflict conversation based on opinion, not data. Technology that uses predictive analytics to create a story around medical necessity rather than just shows a myriad of data points makes the process more efficient and equips the physician to have a productive conversation with the payer. As the ultimate peer-to-peer decision is dependent on the information presented, generating an automatic clinical narrative helps physicians capture all relevant data points and ensures data that could potentially be lost or overlooked becomes meaningful and persuasive. This results in a higher overturn rate for concurrent denials and a protected revenue stream." - Heather Bassett, MD, CMO of Xsolsis