Grant Crossman, Senior Healthcare Consultant, Hayes Management Consulting: To combat the ever growing demand for healthcare billing operations to generate higher margins revenue cycle teams need to be able to share important data regarding productivity and appropriate staffing levels. Factual information regarding the numbers will always trump managers who state that they do not have enough staff.
Consider setting hourly, daily and monthly targets for each department including registration, charge entry, coding, payment posting, accounts receivable and self-pay. Publish the number of expected and/or completed transactions for each department based on a common industry publication like the Medical Group Management Association. Remember to define the type of practice you are working with. Include the monthly expected overall total divided by the number of current working staff to determine whether or not you have the correct amount of employees to complete the tasks for the month. This will help you with hiring new employees, as well as determining overtime efforts.
Provide a list of what a completed transaction looks like. The crucial part of this list is to provide all of the information and work effort that you know is necessary to get the claim paid. For example, for an accounts receivable follow-up, you will want to ensure that your staff has checked the registration, validated the insurance information and reviewed other invoices, including payments and rejections to determine why the invoice they are working on is still outstanding. They also need to call the insurance carrier, re-submit the claim if necessary, include the medical documentation if necessary and put a tickler on the account for additional follow-up after a certain amount of time.
By defining what a completed transaction looks like you can then set targets and start to measure. By setting targets and measuring, your staff will better understand their role, gain a sense of accomplishment and track improvement.
If you would like to share your RCM best practices, please email Carrie Pallardy at cpallardy@beckershealthcare.com to be featured in the “RCM tip of the day” series.
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