65 RCM tips from 2017

Here are sixty-five revenue cycle management tips from industry experts, published by Becker's Hospital Review in 2017.

1. "There needs to be increased transparency into what the status of a claim is so companies can act on the most relevant, verified information available. So if the parties expect this claim to go through more review because it's a complicated reimbursement, then they can act with full assurance on the status of the claim at any given point, knowing the other parties have the same information. It's really about having the right information about how to manage your revenue cycle based on where all of your claims are at any given time." Emily Vaughn, head of accounts at Gem

2. "Every patient accounting system and every hospital defines metrics in slightly different ways. Don't assume the figure means what you expect it to mean. Understand what goes into the number and what it means in context. Examples of this include: a stock discharged not final billed report might include accounts with lag, or only post lag; or accounts receivable or accounts receivable days calculations might be skewed by inclusion or exclusion of credits." Peter Angerhofer, a principal at Colburn Hill Group

3. "Most problems will only get worse and require more time/effort/resources to fix as they progress through your collection process. For example, getting an authorization right at registration might be difficult, but asking patient financial services to get a retro-authorization — after a denial — may be impossible." Peter Angerhofer

4. "Every CEO, CFO should know where they are financially and run their practice as a business. It's not about seeing more patients, it's about being more efficient." Justin Barnes, partner and chief growth officer with iHealth Innovations

5. "There needs to be a process by which the inpatient, outpatient and physician revenue cycles can communicate with one another. It does not necessarily mean they need to be part of the same infrastructure and that you need to have revenue cycle staff that can do both professional and hospital-based coding, but it does mean that they need to have the ability to connect with each other on a regular basis." — Christopher Kerns, a leader of Advisory Board's flagship research membership program, the Health Care Advisory Board

6. "Don't think of a benchmark as the ultimate measure of your revenue cycle performance — often they are set at the 75th percentile, meaning plenty of people are doing far better. Benchmarks are fine as a yardstick, but they should be a starting point, not an end point. Seek out the barriers which limit organizational performance and address them head on. Don't accept the standard ... set the standard." Peter Angerhofer

7. "One challenge to recovery of AR is that while many accounts which are uncollected may be older than the contractual timely filing and appeals limits, they may still be recoverable. Diligent analysis of these low balance claims will divide those accounts into two buckets: uncollectible, or "deadwood," and collectable opportunities." Jeff Means, a principal at Colburn Hill Group

8. "Twelve to 18 months before go-live on a new revenue cycle patient accounting system, organizations gather data for build and testing. Analysis includes cost centers, locations, reports, charge edits, claim edits and claim form logic that will be replicated in the future system. As the initial collection is complete, how will your organization communicate system changes and testing criteria to the responsible team? 

"It is important that a plan be in place to ensure modifications to the existing system are added to the build and test scenarios for the new system. Failure to communicate and test changes effectively could have a significant impact on your revenue. Some organizations maintain a build and testing tracker for modifications. Develop a method to capture changes, additions or tweaks and related testing scenarios to ensure consistent revenue stream after go-live." Aaron Wall, senior healthcare consultant at Hayes Management Consulting

9. "As guidelines on medical necessity continue to tighten their grip on providers, it is important to provide continuous clinical documentation education to physicians. Coders serve as the bridge between rendered services and payments issued to the provider. Clear, concise and complete clinical documentation will ultimately reduce denials and cost-to-collect." Nick Rogers, director of accounts receivable at the Shared Services Center-Sarasota (Fla.)

10. "Recognize the value in collecting a very large volume of low balance accounts, but adopt an intelligent, organized approach to that effort. It is critical to ensure you don't sacrifice — even periodically — the collection opportunity on your high dollar accounts to work a very large volume of low balance accounts." — Jeff Means

11, "Hospitals need to track deposits that are split by the various patient accounting systems and general ledger accounts where the cash actually belongs. This quickly highlights any unposted or unreconciled amounts, allowing staff to resolve those exceptions quickly. [Team members should] log batch-posted data in real-time as part of posters' workflow. The team posting the cash and reconciling the bank account(s) should leverage the same application." Tyler Kurasek, a principal with Colburn Hill Group

12. "Maintaining a routine allows a more consistent application of the posting data. If you track individual deposition transactions, this forces accountability at the transaction level, not by day or month. It's essential to match depositions with batch and transaction files from your patient accounting system. This reduces the many-to-many relationships resulting from the complex posting world in which most providers operate." Tyler Kurasek

13. "Knowing the composition of each deposit type adds much-needed transparency to the reconciliation process. Map each payment to the bank, capturing all points of payments submitted for deposits. Identify the source of every deposit, and whether payments are being rolled into large deposits; by reducing the number of deposits that are grouped together, it allows for easier reconciliation." Tyler Kurasek

14. "Track your clean claims rate daily. Make it a part of regular communication with billing staff and with leadership. Celebrate improvements and then acknowledge problems as they arise to create an actionable plan, so the problem becomes less of an issue. In addition to logging the CCR daily, other metrics to watch include daily field errors; daily claim submission; what is returned from the clearing house; rejected claims — ones that never cleared the editor; and Medicare T-status claims and payer rejection reports." Sara Roberts and Jessica Martin with Colburn Hill Group

15. "The proper use of a contract management system can make a difference of at least 2 percent to 3 percent net revenue. Thus, the proper use of a contract management system should be considered "mission critical," from a financial perspective, but it often does not receive the attention it deserves. Limiting the focus to only recovered amounts neglects the overall purpose and tends to favor only mistakes associated with a relatively low volume of high balance accounts while allowing a high volume of potentially obscure and relatively low balance accounts to remain with balances due. This mentality makes heroes out of the contract management and recovery team but does little to assure revenue integrity. The use of metrics with contract management helps assure all accounts receive appropriate attention and that the hospital gets paid correctly." Roger Shaul, president of PMMC

16. "Providers have been burdened and overwhelmed by the consent requirements for auto-dialing to mobile phones. The clarifications to Telephone Consumer Protection Act have added a need for additional resources — money, technology, employees, time. Otherwise, providers are at risk of non-compliance. Further, patients may revoke consent at any time, which may leave the provider unable to communicate with the patient verbally.

In order to comply, a revenue cycle billing system should have separately identifiable fields to track mobile vs. landline phone numbers and consent vs. revocation, and all of this information must pass to any third party who uses the information to establish patient contact. An investment in robust, call center technology that drives right-party contact productivity will minimize your compliance risk while increasing the volume of successful, legal patient connections so that patient pay conversations can continue." Terry Reinsager, vice president of technology at MediRevv

17. "When you look at profitability and try to understand how well you're doing, if you can ensure a claim goes out cleanly and you don't have to send it a second time, not only are you going to expedite the collections received — you're going to reduce the amount of time and cost spent on collecting the proper payment for that claim." Nicole Davis, senior vice president of channel management at IKS Health

18. "AR is a verb. Accounts receivable is an "action" word. If we expect performance improvement, then we must constantly measure and then actively move. Effective revenue cycle reporting should be developed not only to monitor our current success, but to manage it to the next level." Luanne Yeley, consulting executive for The Halley Consulting Group

19. "Coordinate with managed care contracting and put together a detailed list of the managed Medicaid plans that are contracted with your health system and the associated plan codes to select during registration. Build a training package outlining which payers are contracted, what their insurance cards look like and what services require special attention. This list needs to be maintained quarterly at a minimum." Jeff Means and Sara Roberts

20. "Recent healthcare trends have made it imperative that healthcare organizations drive revenue and accelerate cash flow in a sustainable way. Yet, relying on a number of different partners to manage singular aspects of the revenue cycle — as is status quo for many healthcare providers — invariably results in a lack of standardization across the systems that triggers billing bottlenecks, slows cash flow, suboptimizes revenue yield and impairs quality of care.

"Consider bringing on a single vendor that takes a holistic approach to the revenue cycle — incorporating solutions that span the entire process from patient access to payment resolution. This way, you'll eliminate the administrative burden associated with dealing with multiple vendors and will be assured that every component is optimized and plays well with the next, while minimizing silos." Steve Huddleston, president and chief client officer at nThrive

21. "Nationally there are very few billing editors and regionally there are even less. Ensure your claims editor is configured to handle managed Medicare and managed Medicaid claims as their own claims class. Simply following the commercial claims edits or even just the Medicare or Medicaid edits is not sufficient. Often edits need to be run in a specific sequence to ensure the right outcome is achieved on the final bill." — Jeff Means and Sara Roberts

22. "Managed Medicare and managed Medicaid tend to have significantly higher rates of initial denials (remittances denying line items or entire claims) than commercial or government payers. Tracking these denials in detail is critical. Build a denials management scorecard and a cross-functional team to implement process changes to prevent denials in the future." Jeff Means and Sara Roberts

23. "The healthcare industry is complicated enough without having to wonder if your revenue cycle management company is putting your own business first. When choosing a RCM partner, be sure to consider how the company is bound to the interests of a payer or provider system. Only an independent partner will be able to provide unbiased guidance and act as an advocate on behalf of its clients." Sloan Clardy, chief strategy officer for nThrive

24. "Payers are unlikely to send a check if you haven't sent a bill — look for all of the places a backlog of claims might be hiding. Focus effort on unbilled categories, particularly those within your control. Billing editor queues are a good place to start, but look at other places like Medicare return to provider reports, or claim form edits within the core system." Peter Angerhofer

25. "If hospitals want to improve their collections, it is imperative every patient is asked prior to or at the time of service for a copay, deductible or coinsurance. There tends to be a myth in healthcare that patients don't want to pay their bills. In reality, three out of four patients are willing and able to pay, they just need to be asked. Hospitals need to be transparent and upfront with patients. This will not only increase collections, but patient satisfaction as well." Becky Kinsella, client success manager at Craneware

26. "The key to reducing unnecessary medical costs and adverse outcomes lies in understanding how to best manage your patient population. Payers and providers should invest in a shared platform where the input of clinical and claims data can be leveraged to identify gaps in care and cost-saving opportunities. Cost efficiencies identified through better collaboration should yield better results in value-based contracting initiatives." — Bruce Carver, associate vice president of payer services at MedeAnalytics

27. "Effective revenue cycle management is only attainable when healthcare organizations have a full view of their patient and operational data. Finance departments cannot wait for IT to provide detailed reports, or spend countless hours manually pulling data from EMRs, 835 and 837 remittance and other files. Yet that's what is happening at organizations across the country every day. Instead, by using self-service data preparation and analytics solutions, finance teams can easily unlock hidden data to better manage cash flow, see revenue across service lines, drill down into claims, review aging claims and identify gaps in the revenue cycle process. In minutes rather than hours or days, individuals can determine where corrections need to be made to recapture potential lost revenue." — Frank Moreno, vice president of product marketing at Datawatch

28. "If someone is self-pay, or if someone has been identified as having insurance on a high-deductible plan, offering things like the ability to store their credit card or bank account information to process an automatic and flexible patient-centric payment plan is vitally important." Ric Sinclair, vice president of product at ZirMed

29. "Chronic care management services can be provided by clinical staff (e.g., a nurse or medical assistant) under 'general' supervision versus 'direct' supervision so the billing provider does not need to be on the premises when these services are performed. It is important to ensure that clinical staff performing these services accurately track all the time spent performing the services. For example, if a nurse spends five minutes playing phone tag prior to contacting the patient ... that five minutes counts toward the 20 minutes needed to comply with the billing requirement. Note, this change also gives the RHC/FQHC the option to outsource CCM services." Randy Buchnowski, network executive for The Halley Consulting Group

30. "A true RCM partner will do more than a traditional 'vendor' would when it comes to your revenue cycle. Rather than simply addressing the issues that you are aware of, they will act as a strategic partner, using their industry expertise to analyze trends and identify repetitive or outlying issues that you likely didn't even know were there. The savviest partners will aim to fully understand your business processes and be able to pinpoint the root business issue and identify actionable areas of improvement within your existing frameworks, enabling you to work smarter." — Sloan Clardy

31. "The rules change, staff changes, [RCM] system changes — they all can impact quality of claims that go out. So making sure you're sending out compliant bills is everyone's mission, but it's complicated and can go wrong without any visibility from people managing those departments. If you don't look, you just don't know." Karen Bowden, executive vice president of revenue integrity operations at Craneware

32. "The front office holds the keys to preventing the most frequent causes of denials, including ineligible/uncovered services, failure to obtain prior authorization, lack of medical necessity, incomplete/inaccurate patient demographic information and services covered by another plan or payer. Nearly all eligibility-related information can be uncovered and confirmed prior to the time of service — by leveraging effective and accurate patient eligibility verification technology which can save your staff time and increases their effectiveness, as compared to manual methods. Even if all of the necessary patient information isn't verified ahead of time, it can be quickly verified or amended as part of the check-in process when the patient arrives — so that the patient knows exactly what to expect, and so that you maximize the likelihood of the most accurate and up-to-date information heading downstream to your coders, billers, documentation specialists and others involved in your RCM workflows." — Ryan Feldt, manager at ZirMed

33. "Although many may see the IT department as the owner of an initiative like MACRA, true progress can only be achieved from a cross-departmental collaboration among financial, clinical and IT departments. Financial leaders serving on this committee should be responsible for managing the organization's reporting path, including working with clinical leaders to select the appropriate program measures under either the APM or MIPS track. After all, these program measures are critical in charting the organization's path for quality reimbursement opportunity; it's imperative for an organization to select the measures it can meet most easily. By taking a key role in MACRA initiatives, financial leaders can help their organizations maximize reimbursement and prevent penalties in future years." Joncé Smith, vice president of revenue cycle management at Stoltenberg Consulting

34. "Medical practices face continued operational, financial and regulatory challenges, requiring sound revenue cycle management to maintain — and ideally improve — patient satisfaction, cash flow and overall business performance. The process of managing your clinic's RCM starts before the patient visit and ends when there is a zero-balance owed to the physician. As simple as this sounds, every physician knows from experience what complications and stress the collections process can put on time and resources. This is only further intensified with the new MACRA and MIPS.

"Fortunately, with today's advanced technology, there are platforms available to not only help keep physician's practices on track for success, but also improve overall patient care." Thomas Schildmeyer, vice president of RCM strategy and development at Modernizing Medicine

35. "With pending price cuts to the Medicare laboratory outpatient clinical laboratory fee schedule set to begin in 2018, hospitals can expect to see a 12 percent decline in reimbursement for laboratory testing that is reimbursed under the CLFS. While organic growth can mitigate this loss of revenue, other forward-looking strategies to improve laboratory outpatient collections include effective front-end tools, such as the elimination or reduction of manual billing for new tests not created in the appropriate information technology systems (i.e. laboratory information system, patient accounting system, etc.). Manual orders routinely are priced incorrectly, have incorrect or missing diagnosis codes, are assigned inaccurate CPT codes and are often non-covered or denied by health plans. 

"Other areas of focus should be on laboratory claims that have been denied by payers. While the value of a laboratory encounter can be less than $50, the sheer volume of laboratory claims denied can be material to overall net revenue. Many hospitals have low dollar thresholds for automatic write-offs that could mask opportunities for enhanced laboratory collections." — Jeffrey Myers, vice president of consulting for Accumen and its subsidiary Chi Solutions

36. "Perform the work in a timeframe that will result in cash before your deadline. If you are working toward an end of month, end of quarter or end of year deadline, think about payer processing times and how they impact the timing of your efforts. Commercial payers that pay in 30 to 45 days require activity well in advance — focus there first, before moving to Medicare or other payers that process in 14 to 21 days." Peter Angerhofer

37. "Quality care is increasingly tied to healthy revenue through accurate documentation. This contributes to efficient cash flow and optimizes claims processing from payers that are considering factors beyond traditional length of stay. As insurers turn more toward a Medicare-based, Medicare Severity-Diagnosis Related Group payment model, incomplete and inaccurate documentation can result in lower payments. The spike in the growth of ACOs, also based on the hierarchical condition category payment model similar to the Medicare/DRG payment model, is also spurring the need for more accurate and thorough coding." — Dexter D'Costa, MD, senior director of clinical documentation improvement at Conifer Health Solutions

38. "It's essential to educate physicians on the importance of their role in serving as an advocate of their patients' financial resources, as well as the hospital's. The appropriate level of care is best advocated by undertaking a physician-to-physician review. When payers are reluctant to pay for a specific level of care or procedure, the hospital's physician advisor should engage the patient's specialty physician in a peer-to-peer review. This process ensures that critical, patient-specific information is known and documented." — Theresa Brandon, managing director of Novia Strategies

39. "Many healthcare provider organizations unknowingly fail to bill for 10 percent to 15 percent of their inpatient professional services, leaving a lot of money on the table. One way to remedy the problem is to reconcile physicians' notes with the charges submitted on a regular basis. Because this can be a tedious and time-consuming process if done manually, automation of the task should be a priority for providers with a significant portion of their services rendered in the inpatient setting. This will undoubtedly yield significant dividends." — Paul Brient, CEO of PatientKeeper

40. "To ensure every collectible dollar is received, provider enrollment must become an integral part of the revenue cycle process. Best practices should include regular payer audits to validate provider participation status, rigorous payer application follow up, monitoring of licenses and expiring documents, Council for Affordable Quality Healthcare re-attestations and re-enrollments. Furthermore, understand your at-risk revenue against your open enrollments. These are charges billed by providers when their enrollment status is in-process. In-process enrollments for payers with the highest at-risk revenue should be managed with the highest priority." — Patrick Doyle, senior vice president of Newport Credentialing Solutions

41. "As the portion of the medical bill paid by patients rises, more and more patients will struggle. That's why it's crucial that providers respond with immediate assistance, making it simple and easy to set up affordable payment plans which not only alleviate stress for patients, but also ensure that your organization gets paid in full. The best approach is to have an automated system for setting up and managing payment plans which allow for automatic deductions from the patient's bank account or credit card. We recommend patient payment systems that assist staff in setting up payment plans for patients while onsite as well as systems that allow patients to initiate and set up their own plans in a self-service capacity, transforming patients into empowered consumers." — Dustin Hamilton, director of product at ZirMed

42. "Organizations can instead [of employee layoffs] elect for a natural migration phased over a period of time and receive more meaningful work from the employees they retain.

"This migration could play out in several ways. To start, perhaps your RCM partner picks up all growth from your new physicians or any acquisitions your organization makes. Simultaneously, should you have attrition in your workforce, you can avoid backfilling staff — saving you downtime, recruiting fees and ultimately a higher salary and benefits for that employee — by moving the work immediately to your partner. Another opportunity is for your partner to work aged accounts receivable or claims that your existing team doesn't have resources or time to work.

"What's more, as your relationship with a competent partner grows and you're beginning to see the cash wins they bring to the table, you can start to rededicate your existing employees to new tasks, putting them to work at the top of their skill set. Helping your employees refocus their workflow can improve the patient experience, financial strength and better align your organization. This might include a deeper focus on patient outreach, pre-authorizations and improving practice quality metrics, which all impact reimbursement. It's a win-win because you now have two sets of skilled team members focused on improving practice revenues. In our fee-for-value future, organizations that get this work right are the ones that will remain." — Leonard Wenyon, vice president of solutions at IKS Health

43. "As patient responsibility for healthcare costs continues to rise, offering payment plans (either self-service or through a financial counselor) is a well-established convention that many healthcare organizations utilize in order to provide as much flexibility as possible to their patients. However, we've found that in many cases, once rules and term options are set, they are forgotten and rarely changed, especially on the self-service front.

"A fixed sliding scale taped to the side of a financial counselor's desktop is outdated and ineffective. It's important to understand how your patient population is responding to the options that you've given them (whether it's payment plans or any other payment vector) and be able to effectively use that data to quickly adjust if necessary. We recommend utilizing a system that not only services your core revenue cycle needs but also continually monitors key metrics to automatically adjust and optimize itself to best fit the needs of your patient population." — Jason Kuo, product manager at Patientco

44. "In addition to collecting copays at in-person visits or during a pre-visit, it's possible to educate patients about estimated charges related to coinsurance and provide the patient with insight on meeting deductibles. An effective patient estimation application can help predict the patient's total financial responsibility based on insurance coverage, plan design, type of encounter and procedure information." — Dustin Hamilton

45. "To make sure that your organization is quickly paid what it is owed, make sure that claims are coded right the first time — a task that has become more challenging since the advent of ICD-10, which has over 68,000 coding options compared to the 13,000 ICD-9 codes. Look for a set of automated coding tools that integrate with your claims software to ensure compliance with local coverage determination and national coverage determination regulations. These systems also allow you to search within specific sub-sets so only codes relevant to your practice or organization appear in search results." — Dustin Hamilton

46. "Successful issue tracking ... can help hold your staff accountable as well as track progress of tasks during a project. When documenting all issues you can prioritize while ensuring the issue does not fall through the cracks. Formal documentation shared with all parties keeps everyone in the loop and on the same page, including who reported the issue, why it is considered an issue and who it impacts.

"Issue tracking can be handled a couple different ways, including using a commercial software package that assigns a ticket number or using an Excel spreadsheet. In order to be effective, you will need to ensure that all vital pieces of data are collected so you can track and monitor progress, prioritize and identify next steps and have a communication tool. Communication is key as you want to ensure all parties can review to understand the issue, status and responsible party.

"Issue tracking must be reviewed with all parties involved on a regular basis to ensure issues are reprioritized and resources are allocated properly to meet all targeted due dates. The Issues List is a tool you need to communicate and hold people accountable so you can move issues to completion to accomplish the ultimate goal of the project.

"By effectively tracking your issues, you can improve your revenue cycle by prioritizing the issues with the largest impact on fiscal management, revenue cycle processes and workflows and ensure personnel are held accountable to meet target dates and goals." — Cynthia Ethier, senior healthcare consultant of revenue cycle transformation at Hayes Management Consulting

47. "Historically, clinicians have been involved primarily in the inpatient mid-cycle arena to support the resolution of payer denials. With more robust technology being used to manage the revenue cycle and the increasing numbers of payer onsite nursing staff, expanding the involvement of hospital clinical staff is crucial to securing agreement on approved days and level of care. Engaging clinical staff during the pre-authorization process decreases risk of rework related to incorrect or insufficient documentation in support of authorization. Ensuring that care management is communicating daily with the onsite payer nurse to confirm approval of services reduces the risk of underpayment or late denial notification. Matching the hospital's internal skill set with those of the payer-reviewers allows critical sharing of clinical information and real-time resolution. This investment of skilled clinical resources improves the efficiency of revenue cycle processes and reduces the risk of write-offs." — Theresa Brandon, managing director of Novia Strategies

48. "Write-off volumes and dollars are often symptoms of ineffective or non-existent processes and should be used as a signal and opportunity to improve operations. However, unless the codes are used accurately and consistently applied, staff may be deployed on lengthy investigations that do not resolve underlying issues. Limit access to write-off codes to well-trained team members. Engage them in discussions on recent examples of the use of various codes. These conversations will likely be enlightening to all involved. In addition, conduct reviews of write-offs and the underlying situations to determine if the codes are being used correctly by all team members. Some of the most commonly misused codes include untimely filing and contractual adjustments, which too frequently contain avoidable write-offs. Ensuring that your write-off data is accurate before using it to investigate potential process improvements will result in more effective use of staff resources." Theresa Brandon

49. Payer "contracts have become increasingly complex and require close review to ensure payer expectations can be met. Sharing all language changes with key stakeholders provides the organization an opportunity to gauge whether an addendum is 'just semantics' or necessitates a different level of interaction with the payer. Maintaining and systematically updating and sharing a payer matrix provides an excellent, quick reference for frontline staff. Including the top 15 to 20 payers will provide frontline staff with the knowledge needed to best support the revenue cycle. To further equip staff with the necessary tools to enhance reimbursement, focus on providing the most critical aspects of the contracts — reimbursement type, special provisions, stop loss/outlier payment, timeframe for notification and appeals." Theresa Brandon

50. "Often denials come back with generic coding explanations that can lead to incorrect assumptions about why claims were denied. To keep it from happening again, trace claims with the same reason codes and do root-cause analyses to find the true reasons for denials and add custom medical claims edits or place existing edits earlier in the appropriate system workflow. You may also need to apply modifiers not only in the edits but in the clinician's workflow or with the case management team as they identify services rendered for the claim. Each of these scenarios requires consistent and timely problem-solving to keep edits up to date and claims moving toward adjudication."

Additionally, "denials management and resolution are time consuming and results don't come overnight. Once a root cause is identified, it can take weeks of follow-up to correct the internal issues that led to the denial. A knowledgeable, dedicated mitigation team; current technology; a sound strategy; and constant attention are essential for a robust denials resolution process. If your teams aren't robust enough to handle these tasks on top of their everyday role, consider outsourcing to an experienced partner who can help establish medical billing benchmarks, reduce backlogs, identify root causes and augment your revenue cycle team." — Kamron Lachney, vice president of hospital operations for Change Healthcare

51. "Many hospitals and practices ignore the significance of a strong front end. My motto has always been, 'If you do things right on the front end the first time, you won't need a back end.'

"By educating registration staff and giving them the tools to be successful, you can reduce the rejections and denials due to registration errors.

"Verifying insurance eligibility not only confirms the patient is covered by the carrier, but can also provide accurate billing data such as certificate or group number. Providing a registration hotline for registration staff to your central business office to address questions can prevent staff from having to guess when they are unsure how to resolve a front-end registration issue.

"Training registration staff on the system, insurance products and process can reduce rejections and denials, and verifying insurance eligibility while providing a registration hotline can ensure you are on your way to a clean front end while reducing one of the most preventable reasons for claim rejection or denials. Clean claims are an effortless way to reduce your accounts receivable days and enhance your revenue cycle." —Cynthia Ethier

52. "We all know that people look at their billing statements, which we estimate have an open rate of 95 percent or higher for existing customers. So use the prime real estate on those bills to add marketing messages and educational information to improve customer engagement and create stronger relationships. One eye care network, for example, includes the dates, locations and fees for its educational seminars. Or send heart patients information about cardiac-related wellness programs in their billing statements." — Bryan Ten Broek, vice president of business development at Nordis Technologies

53. "In healthcare today, one in five claims is denied or delayed and a startling 90 percent of those denials are preventable. Yet, most healthcare organizations still focus on appealing denials rather than addressing the root cause of the issues so they can avoid them.

"To implement a denial prevention strategy, health systems must take a multipronged approach. One key piece of that strategy is a renewed focus on verifying patient eligibility. The vast majority of denials — as much as 75 percent — are the result of problems with patients either being ruled ineligible or not covered for certain services. It only takes a small error, or one missing piece of information, to turn a legitimate claim into a denial. Manual approaches to verify eligibility and coverage of services during scheduling and registration processes are time-consuming and laborious, often requiring multiple phone calls or logging in to a payer's website. Even if all the information is obtained, if it is entered incorrectly into the system it can still result in a denial. Eligibility verification technology can solve these issues, ensuring a patient is eligible for all the intended services before they are provided — right up to the time of check-in. Automating the information-gathering process ensures the patient and service data is entered accurately, without the risk of introducing human error. By sending quality information to the back-office staff, the organization can ensure claims are as clean as possible, reducing denials and the administrative burden of attempting to fight them later." — Dustin Hamilton

54. "If a provider is not properly enrolled, they will not get paid. A participating and nonparticipating analysis is the process of validating the participating status of each provider across all plans, locations and tax IDs. This analysis is critically important in that it creates a baseline of who your providers are enrolled accurately with — and who they are not. By establishing an enrollment baseline and identifying which providers are not enrolled with your plans, you can take proactive steps to enroll them correctly to avoid lost revenue." — Patrick Doyle

55. "From check-in to the insurance verification to billing, data analytics can help you identify where the biggest opportunity for improvement lies. Are patient no-shows causing you to lose money? Data analytics spots these trends and helps you course-correct the problem (i.e. set up appointment reminders for patients)." — Tom Schaal, director of product management at MedeAnalytics

56. "Both patients and providers benefit from discussing the patient's share of costs before treatment, but it takes a real shift in processes and behavior. Here are three steps to getting there:

  1. Use a price estimator
  2. Offer a range of payment options, including a prompt-pay discount for those willing to pay with cash, check or credit/debit cards; a low or no-interest payment plan; and charity care
  3. Invest in training and develop a specific script for frontline staff so they can speak comfortably with patients about paying their bills" — KaLynn Gates, president of Springfield, Ore.-based HealthFirst Financial

57. "High-deductible health plans and the number of uninsured will grow in 2018, putting more pressure on providers to collect from patients. Developing a solid segmentation strategy that looks for missing insurance, identifies financial assistance/charity and tiers accounts into the appropriate activity group will be key. This will maximize resource activity and provide the best return for providers." — Shawn Yates, director of healthcare product management at Ontario Systems

58. "Healthcare organizations should constantly measure their performance against their competitors to identify areas for improvement. To do this, organizations need to invest in an analytics platform that translates competitor data into meaningful insights. The value of benchmarking is knowing if you're competitive and what other organizations are doing better than you — if they have better patient outcomes, higher revenue, you name it." Destiny Schroeder, information systems director at Atwood, Kan.-based Rawlins County Health Center

59. "In particular, these are the five key performance indicators that warrant extra scrutiny to identify opportunities to increase revenue, accelerate payment and reduce costs to collect:

  • Discharged, not final billed
  • Clean claim rate
  • Payer aging over 90 days
  • Net collection percentage
  • Hospital Consumer Assessment of Healthcare Providers and Systems

"Once you start monitoring these metrics on a continual basis, you are going to start to see trends and areas where you can improve. That might be the front desk staff, physicians' bedside manner, scheduling or billing processes, and from there you can begin to make an impact to both the bottom line and the patient experience." — Kamron Lachney

60. "To reduce the downward pressure faced by medical practices, it is important to automate the complex and time-consuming AR management process. It reduces the costs involved in receivable processing and provides a wealth of AR data that serves as a continual feedback loop.

"Automating the AR process leads to a repetitive process that can be easily monitored as opposed to fragmented bits of AR information that are scattered across the organization. It also leads to quicker AR cycles." — Steve Watson, regional director of quality assurance at AnesthesiaBillingBridge

61. "In my experience as a revenue cycle manager, I've noticed 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 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

62. "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

63. "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

64. "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 days, 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

65. "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

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