6 recent RCM tips

Here are six revenue cycle management tips from experts, published by Becker's Hospital Review after Aug 2.

1. Jim Dougherty, CEO of Madaket Health, recommended cutting out manual, error-prone processes in payer-provider transactions. He said healthcare organizations should automate enrollments necessary for payments.

2. Lyman Sornberger, vice president of client development at Charles J. Hilton and Associates law firm, provided three operational processes in revenue cycle management to respond to insurance claim denials. These processes include informal and formal appeals. He said providers also may bring in a third-party healthcare attorney to respond to denials.

3. Kevin Smith, vice president of product management at nThrive, said hospitals should use technology to examine changes before bills are sent to patients and identify areas of potential charge discrepancies. A strong charge integrity program "provides a billing safety net that health systems can count on to capture revenue, increase operational efficiency and improve billing compliance. The more comprehensive your strategy, the more effective the results," he told Becker's Hospital Review.

4. Heather Bassett, MD, CMO of Xsolis, recommended using objective analytics to work with payers during case management. "Not only are analytics important for hospitals when reviewing cases for severity of illness and intensity of service, they can be used as an objective framework for assessing the appropriateness of care," she told Becker's Hospital Review.

5. Tyler Kurasek, a principal at Colburn Hill Group, an end-to-end revenue cycle solutions firm, recommended looking to analytics when using robotic process automation to improve RCM. "Using analytics to find patterns of claims that may not have the same characteristics, but require the same next step, is one way to build a volume of tasks that justifies using a robot," he said. "Once the patterns are identified, and the robot is built, managers need to monitor its use and activity to ensure not only that all claims which qualify are being processed, but also that any new populations which should qualify are included."

6. Tom Romeo, general manager of healthcare IT and Quanum Solutions at Quest Diagnostics, said hospitals and health systems must identify the cause of insurance claim denials to ensure proper and timely payment. "Identify the source of denials through reports and discussions with staff, and then prioritize fixing the problem," he told Becker's Hospital Review. "Train staff about these issues and review top denials regularly in meetings with physicians. It's critical to recognize the contribution of every employee in the denial-management process."



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