6 recent RCM tips

Here are six revenue cycle management tips from industry experts, published by Becker's Hospital Review so far in 2018.

1. "If a hospital lets an account age in their receivables, they can quickly let six months lapse and any rights to appeal the denial can go by the wayside. So timely and early identification [of claim denials] is important, whether that's dedicating a team to it or spending money on software to help them identify and then categorize the types of denials the hospital is seeing." - Brandon Rife, president of Kemberton

2. "As the New Year begins, insurance benefit deductibles will reset to zero. Providers can prepare for the New Year by reminding and training front office staff to verify insurance plans and benefit levels for all current patients; verifications should include copay, coinsurance and deductible requirements. I recommend establishing a protocol such as a 72-hour verification period policy for the physician practices. By verifying benefits within a short window of time before the patient's appointment, the staff will help ensure patients are prepared to pay upfront costs because they've been informed of financial obligations in advance. If payment isn't collected at the point of service, the window to collect payment quickly shrinks once the patient leaves the office." - Leonard Wenyon, vice president of revenue cycle management solutions at IKS Health

3. "It's no secret more employees are choosing high-deductible health plans over the higher-priced options to help control costs. However, when care is needed, they oftentimes find themselves at risk for increased medical bills, resulting in the struggle to meet their financial responsibilities. In fact, a report put out by TransUnion Healthcare states nearly 68 percent of patients with hospital bills less than $500 didn't pay the full balance in 2016.

"To minimize these effects, healthcare providers are faced with the challenge of finding ways to help patients understand their financial obligations earlier in the encounter to avoid uncompensated care. This includes the use of RCM software to better serve patients by offering payment plans or alternative payment options.

"These emerging technologies can help physician practices, hospitals and health systems give patients the experience, transparency and consumer-friendly options they want. In years past, greater technological capabilities often meant greater complexity, but now healthcare organizations are finding it creates a more seamless experience." - Matt Hawkins, CEO of the newly combined Navicure and ZirMed company

4. "Recently I was working with a revenue cycle director who researched root causes for registration and eligibility denials and identified a specific clinic with a denial rate of 42 percent. This director contacted the clinic and asked the clinical director, 'Why does your location have a denial rate of 42 percent due to registration and eligibility denials when the industry standard is less than 5 percent?' The clinical director quickly researched the issue in search for the root cause and found the newly hired staff were not terming inactive insurance properly. The director successfully resolved the problem by training staff how to verify insurance by using the verification tool, teaching them how to term the inactive insurance, how to confirm primary insurance, and how to collect co-pays from the patient at the point-of-service.   

"Although the clinical director in the example above found the root cause and a solution, audits were established and conducted to monitor staff productivity and ensure they continued to complete processes correctly. The location's denial rate went down 20 percent within the first month after training was completed and POS collections increased 50 percent. The denial rate continued to decrease for this clinic and staff began to communicate issues with insurances as they experienced them. Because the revenue cycle director had asked 'why,' the root cause was discovered, a solution was found, and the clinic's increased revenue followed.

"Continue to ask 'why' for every denial until the root cause is exposed. Once the solution is determined, then strategize and develop a plan of action to diminish the reoccurrence." - Susan Eilman, senior healthcare consultant for revenue cycle transformation at Hayes Management Consulting

5.  "Hospitals confront tough challenges in delivering better health outcomes with lower medical costs while maintaining CMS regulatory compliance and optimizing revenue. [Therefore], planning a competent risk adjustment strategy and deploying right population health management systems with some professional advice becomes imperative. This helps to automate workflow and data sharing, manage compliance, optimize revenue with accurate HCC [Hierarchical Condition Category] codes and improve [Overall Hospital Quality] Star Ratings altogether." - Nancy Lopez, a revenue cycle manager for the lost revenue recovery program at BillingParadise

6. "Starting in 2018, the MIPS [Medicare Access and CHIP Reauthorization Act's Merit-based Incentive Payment System] final performance categories will shift not only in weight, but also some of the categories will require additional reporting data than was previously expected. The weight for each performance category will be: Quality (50 percent), Improvement Activities (15 percent), Advancing CARE Information (25 percent) and Cost (10 percent).

"Eligible or not for 2018 reporting — revenue cycle leaders should pay close attention to the new requirements for both Cost and Quality. For example, Cost's weight in the final MIPS score is the most significant shift revealed by CMS for 2018. Previously, it was expected to still weigh in at 0 percent of the final score. By 2019 (the 2021 payment year), CMS plans to increase cost to 30 percent of the total performance score. For 2018, it's also important to note that both Cost and Quality require an entire year of reporting. The best way to respond to these changes is to collaborate with a cross-departmental team that can identify needed initiatives to ensure the organization can maximize its reimbursement" - Joncé Smith, vice president of revenue cycle management at Stoltenberg Consulting



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