5 strategies to increase hospital outpatient revenue cycle profitability

As hospitals continue to experience the growth of outpatient, outreach and ambulatory centers, a cost-effective approach is critical, because lack of one can result in uncollected claims. Often hospitals and health systems rely on their existing EHR technology to handle all claims but for outpatient related services this might not be the best approach.

During a Feb. 25 webinar, hosted by Becker's Hospital Review and sponsored by XIFIN, presenters recommended five strategies to supercharge hospital outpatient-related revenue cycle profitability.

Presenters from XIFIN were: 

  • Brian L. Kemp, VP, Strategic Revenue Cycle Operations & Initiatives 
  • Lynnae Riggio, Senior Director of Hospital Diagnostic Services

The five strategies:

1. Automate to improve clean claims processing. Within the revenue cycle, missing or inaccurate demographic, diagnosis and/or insurance information can result in errors that prevent claims from being billed. XIFIN said automation and minimizing individual clerical decisions are key to improving the front-end process to ensure error-free claims are billed faster. The company recommends automated insurance eligibility checks and automated consolidation rules based on payor requirements.

2. Enhance denial management process. Effective claim denial management is crucial to an organization's financial picture because an inefficient process can lead to lost revenue. Various automation  tools can help. For example, XIFIN offers payor specific front-end claim edits received in real time, which they said allows faster resolution of front-end claim rejections. The company also can set up reason codes or denial codes to automatically appeal claim denials, as warranted based on supporting documentation such as medical records, lab or pathology reports.

3. Raise your data IQ. Knowing key performance indicators, such as point-of-service cash collections and clean claim rate, at the department level and across outpatient settings, is a way to measure revenue cycle efficiency. To know these indicators, organizations must have an easy way to retrieve data, XIFIN said. They must also take a deeper look into aspects of the revenue cycle, whether that is done in-house or through outsourcing.

4. Complete a compliance review. Revenue cycle teams and outpatient departments should include compliance planning and monitoring within their workflows, according to XIFIN. This is because of ever-changing state and federal compliance regulations. Organizations that don't keep up with compliance regulations risk losing earned revenue and could face penalties for noncompliance, such as recoupment of payments and fines.

5. Become patient access and physician engagement centric. Patients are increasingly taking on more financial responsibility for their medical care. However, patients don't always have clarity about their potential out-of-pocket costs, which can lead to dissatisfaction, said XIFIN. The company recommends hospital outpatient services and referring physicians collaborate and use automation to provide clarity for patients about their costs and boost efficiency with data exchange to improve finances.  

To access the webinar recording, click here. To learn more about XIFIN, click here

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