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Healthcare Revenue Hacks

5 Smart Tips for Improving Revenue Cycle Management

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5 Smart Tips for Improving Revenue Cycle Management

Looking to Improve Your Revenue Cycle Management?
The growing challenge of rising provider costs, a volatile healthcare market, and patient debt may seem impossible, but that is precisely why revenue cycle management is so important. Revenue cycle management is dynamically evolving under a growing value-based approach to care in an age of digital innovation. As a result, providers, from single-doctor family practices to large hospital systems, quickly have to learn to adapt.

How Does Value-Based Care Affect Revenue Cycle Management?
As the healthcare industry shifts in part to a more value-based approach to care versus a fee-based approach, revenue cycle management is remolding itself again. What does this mean for providers?

Smart Tips for Improving Revenue Cycle Management
Improving revenue cycle management might seem like a lofty, costly, and time-consuming goal. However, it’s “the little things” which can add up to the most significant impact.

Smart tips for improving Revenue Cycle Management include:

 1. Enhance Pre-Admission Contact

Want to boost cash flow fast? Going the extra mile before a patient’s admission may do just that. Make contact before an appointment or elective procedure with a simple phone call or an email directing patients to printable forms they need to fill out, confirm how and when payment is processed, and explain what to expect at the appointment/procedure.

Connecting before admission also speeds up registration time the day of admission and allows patients to ask any questions or voice any concerns they may have. This, in turn, establishes a solid and friendly foundation from which patient loyalty will grow. Therefore, your team in charge of intake and registration should feel inclined to achieve as much as possible in this beneficial window before patient arrival, even going so far as to verify contact information (including email address) and even potentially to take payment over the phone.

Your front-line staff who handle pre-admission communication and registration workflows are a vital point of contact for understanding where roadblocks in the process lie. Regularly survey and conduct dialogues with this staff, especially as data insights reveal trending mistakes or tasks that take too much time. In addition, you may be surprised to learn that simple office upgrades like standing desks, new headsets, or back support for office staff chairs can significantly impact the front-line experience and team performance. 

 2. Use Software Solutions to Streamline RCM

Digital solutions through revenue cycle management software and online patient portals are necessary for streamlining patient communication and payments. Cloud-based RCM software offers medical providers the unique ability to aggregate claims filing, invoicing and payment transactions, appointment scheduling, and patient data (among other things) all in one convenient place.

Insights into patient trends, i.e., rates of visits, occurrences of chronic illness, payment rates, etc., can help your organization make data-based decisions regarding updating technologies and services. And housing all accounts receivable information in one central place can make the patient intake, billing, and payment processes more efficient.

Patient portals like Phreesia, which allow patients to check-in or reschedule appointments, access health records, resolve outstanding balances, request refills, and message doctors, also empower patients to take a more prominent role in their health and wellness. Of course, the value of healthcare comes across not just through the treatment and medicine which helps a patient recover from illness. Still, in the steps, a medical provider takes to help a patient prioritize transparency and prevent disease. Interactive online tools that give patients more control over their health management reflect well on both the goals of your office as well as your modern embrace of technology.

3. Appoint a Dedicated Care Coordinator

Under a value-based care net, increasing patient volume and ordering more tests and treatments no longer guarantees more payout from insurance companies. Instead, government programs and insurers are looking further past the quantity of a provider’s care to the quality and efficacy of their care.

Understanding the transition in policy by which payouts and reimbursements will be measured by the quality of care as well as the efficiency of the organization will require the involvement of a dedicated care coordinator. A care coordinator can stay updated on legislation and policy changes, update your organization’s financial policy, and work with providers and patients to optimize care under the new value-based model.

Positive medical outcomes will be the product of more vital patient/provider collaboration. Care coordinators can serve as those liaisons between both parties, helping clinicians better understand patient concerns and health hurdles and motivating patients to claim a more significant role in their treatment and wellbeing.

Care coordinators can also organize health and wellness clinics that exist outside of the day-to-day appointments and procedures and which do in fact, optimize the quality of care patients receive. Billing, coding, and collecting will no longer be the only force by which revenue cycles churn. Care coordinators can play an essential role in ensuring health systems and providers recognize care quality goals and formulate programs that provide the highest payouts, boosting patient loyalty and health outcomes.

4. Improve the Patient Financial Experience

The coverage landscape has changed so drastically in the past two decades to a point where some healthcare organizations which were once receiving only 10% of all payments from patients (the rest paid out by health insurance companies and the government) now rely on patients to make up over 30% of all charges.

A volatile marketplace combined with fluctuating legislation has driven many patients to buy into high-deductible plans with low premiums. These types of insurance plans are more affordable on a month-to-month basis for patients but often leave patients footing the bill for the entirety of all their appointments, prescriptions, or procedures. In addition, a report from the Advisory Board found that the higher a patient’s deductible, the less likely they were able to pay for their care at the time of service.

Patient adherence to payment requirements can vary from organization to organization and often are not met because of reasons including:

  • Patient inability to pay the amount required    
  • Patients did not know they owed money.                
  • The patient does not have needed payment method (i.e., your office requires a check or cash, and they only have a credit card)
  • The patient disputes the charge.
  • The patient doesn’t understand the bill.
  • The patient missed the bill in their mail.
  • Filing errors sent the bill to the wrong place.

Providers can take small, manageable steps to improve the rate of patient payment, including verifying accurate contact and mailing information before admission, offering multiple methods of payment (i.e., credit or debit, payment plans, online portal, etc.), and collecting copayments before treatment.

Providers also need to recognize shifts in patient expectations and act accordingly. For example, an older patient might be used to getting a bill in the mail, while younger adults in their 20s and 30s might rely more on email and text messages for payment and appointment communication.


5. Measure, Measure, Measure

Simply knowing your organization is behind on collecting payments or is making too many errors when filing claims isn’t enough. Successful revenue cycle management relies on measuring key rates and statistics and setting common goals to measure the efficacy of workflow changes and updates to existing protocols. 

Collection rates, for example, paint a picture of the percentage of patient payments that are successfully captured during a billing cycle. Medical providers want those rates above 85% minimum and even closer to 95 or 100%. While the hard truth is that some patients will never resolve their balance, it’s critical to learn how many are paying and what steps can be taken to increase that number.

Advanced measuring of critical metrics and benchmarks can also highlight recurring discrepancies in claims filing, denials, and billing. Keener oversight might reveal irregularities in specific payor denials, helping to pinpoint potential issues worthy of contract negotiation.

Other vital statistics worth monitoring are how many claims are denied and for what reasons (i.e., typo, coding error, missing information), the average number of days it takes patients to settle a bill, and how often patients miss appointments when they are reminded via phone call versus email or text.

While consistently the topic of political debate, the continued evolution of the healthcare system in America will largely be shaped by the patients themselves and those medical providers who treat them. On the patient side, you have growing rates of obesity, heart disease, diabetes, Alzheimer’s, and other chronic conditions which require ongoing medical care. Combined with an aging populace of Baby Boomers who will all age into Medicare eligibility by 2030, providers have an explosive reason to optimize value-based payouts.

How healthcare organizations adapt to both value-based payout models and mounting demand for digital solutions will forge the future of revenue cycle management as the country knows it.

Categories
Healthcare Revenue Hacks

Revenue Cycle Management Tips and Tricks

We offer additional revenue streams!

Revenue Cycle Management Tips and Tricks

Drug rehab and mental health treatment facilities’ financial stability relies mainly on their capability to collect payment in a timely fashion. To promptly ensure receivables collection, it is necessary to either have an in-house billing team that runs like a well-oiled machine or finds a stellar third-party billing partner.

When it comes to operations in the behavioral health industry, Revenue Cycle Management is not usually the first thing that comes to mind. However, as this industry continues to become more competitive, streamlining your billing operations is crucial. This guide will help outline this process.

Revenue Drivers for Behavioral Health

Hopefully, during the strategic planning of your program, key revenue drivers have been established. These revenue drivers are dependent on your program’s specific type of business model: inpatient or residential vs. outpatient.

There are similarities in foundational revenue drivers in terms of substance abuse and mental health insurance reimbursement. These start even before a potential client steps one foot in the door and can continue long after they are gone:

  • Verification of mental health and substance abuse benefits (all levels of care).
  • Detailed clinical note-taking, proper record keeping, communication between line and clinical staff.
  • Billing and submitting claims, payment tracking, client account administration, and denials management (including underpaid and missed claims).

Your program’s ability to execute all these tasks consistently and efficiently is directly related to the amount and timeliness with which you will receive reimbursement.

  • Staff-to-client efficiency
  • Census level
  • Cost of programming
  • Claims reimbursement from both Medicaid/Medicare and private health coverage
  • Client claims (coinsurance, copayments, deductibles, etc.)
  • Collections

These internal drivers are all controllable and can be easily improved upon with some consistent processes and follow-through. However, many organizations struggle to deal with external variables, like collecting from insurance carriers, patients/families, and other payers.

When trying to optimize your revenue cycle, you have to consider the existing setup of private and insurance pay processes. For example, insurance carriers can take weeks to reimburse stays at behavioral health facilities.

Each entity will have its method of checks and balances to make sure their policy member requires treatment and how much and how often reimbursements will be paid.

Many facilities operate from a dated business model: payment can be made after services have been rendered. Although this approach can help with the increasing census, it will end up with longer collection times and ultimately a payment level that equals less than the total cost of care.

Pre-paying and Reimbursements

Claims, claims, claims. There is a reason third-party billing exists and that there are experts within all the different areas of billing. Insurance claims reimbursement—especially for mental health and substance abuse—is not a simple process. It is also an increasing, significant portion of a facility’s overall revenue (compared with private cash pay).

  • Claims reimbursement starts with proper claims management.
    • This process involves meticulous note-taking
  • Reimbursement rates negotiation – all levels of care including:
    • Inpatient
    • Residential Treatment (RTC)
    • Partial Hospitalization (PHP)
    • Intensive Outpatient (IOP)
    • Routine Outpatient (ROP)

The negotiation of contracted rates for behavioral health reimbursement can vary state-by-state and region-by-region. Some different laws and regulations govern how care is administered and how it is paid for and reimbursed by insurance carriers.

Navigating these waters is a full-time job in and of itself. If your program does not have room or resources for a dedicated staff member or in-house team, it is best to connect with outside experts.

This includes an organization that is knowledgeable and understands:

  • The lengthy legal appeals process
  • The ins and outs of coding
  • The subtleties of mental health and addiction language
  • Timely filing and follow up
  • Quality assurance

A common occurrence with insurance claims is that they are either fluctuating and underpaying or not paying at all. If someone is not watching these claims daily, keeping your revenue cycle management on point can be challenging.

A recent in-depth report by 60 Minutes found the claim denial rate often exceeded 90% by Anthem in cases it reviewed.

Even facilities running their billing operations as smoothly as possible can still face an uphill battle to keep a solid, timely, and the total amount of reimbursements coming in. Rejection rates will continue to rise as insurance becomes more expensive.

The other factors involved in keeping a solid revenue cycle from insurance reimbursement are the other payables: deductibles, co-pays, and coinsurance. Because of the recent spike in health insurance premiums, there is a correlating rise in people taking on more cost-share.  This means that your cash pay collection processes will be put to the test as well.

Collections and Margins
For any type of collection to make sense, it has to make cents. It does no good to go after receivables or debts that cost you more to get them than they are worth.

More than likely, the lion’s share of your revenue will come from reimbursement; however, most of the work put into collections will be in getting private pay clients to pay for services rendered.

You have to realize that private health insurance paying for drug rehab or therapeutic boarding schools is a relatively new concept. This option essentially did not exist before the Affordable Care Act was put in place. Because of this, debt collection from insurance reimbursement is now a severe pain point for behavioral health facilities.

For instance, with Blue Cross Blue Shield, all reimbursement checks are sent to the family and not the facility. This creates an additional step in the process and a huge problem/delay in revenue collection. In addition, because the insurance process is complex and cumbersome, many parents do not realize that the reimbursements they receive are not theirs, putting tension on all parties involved.

There was and still is a huge learning curve for proper and diligent insurance billing. Therefore, to maximize the allowable reimbursement amount, it is essential to watch the accounts owed for all significant insurance carriers closely.

It takes a serious amount of resources, including staff who can:

A good revenue cycle in this industry should never get beyond 40-50 days.

If enough resources are allocated to keep things organized and processes flowing smoothly, this should not be a problem.

To summarize, a facility must streamline:

  • Verification of benefits
  • Collection of any coinsurance, co-pay, or deductible upfront
  • Utilization reviews
  • Referral management system
  • Claims follow-up
  • Denials management

The Right Resources for the Right Job

The world of healthcare and healthcare billing is a complex one—a world that, by its very nature, works backward and involves extreme delays in payment cycles. However, even with these long payment cycles, you should take steps to accelerate the processor to minimize unnecessary delays at most minor. Otherwise, an average of 40-50 days for payment can turn into 90-120 days.

Here are some tools you can use:

Roadmap

Think of billing as a chain-linked process. Those involved with an insurance pay client, including the initial touchpoint, have to understand the entire roadmap from start to finish.

Everyone involved needs to understand what codes will be used, the process of filing a claim, and whether or not their health plan will be a good fit upfront.

Software, The Web, and Being Mobile

  • Electronic Health Records
  • Client Relationship Management
  • HIPAA Compliance
  • Mobile Friendly

Knowing these technical terms is instrumental in streamlining a facility’s revenue cycle and conducting overall operations. There are many options in the HealthTech world, and which software you want to use will depend on the size and needs of your facility.

Once you choose the right technologies for your needs, here are some helpful hints to speed up the revenue cycle:

VOB

  • Verify insurance online through the carrier portals to avoid long call wait times, and be sure to double-check benefits.

Payments

  • Collect all insurance payables upfront and offer to reimburse clients after insurance has made payments.

Tracking Patients

  • Training therapists and support staff to properly document their client encounters, admissions, and discharges with quick notes and details.
  • Make sure clients have primary diagnoses as well as secondary diagnoses if warranted.

Insurance Billing

  • Once you have submitted a claim, make sure someone follows up within at least 72 hours to make sure it has been accepted by the clearinghouse and processed by the carrier.
  • Insurance billing reporting will allow you to forecast financials and show trends in health care plans, diagnoses, payment cycles, and much more. Make sure whatever billing software you use has a solid reporting functionality.

This is all easier said than done. It requires a quality team of reliable professionals dedicated to keeping your facility running as efficiently as possible. Your revenue cycle management should be a living, breathing process that constantly revisits, adapted, and updated. Don’t get complacent!