When was the last time you reviewed your revenue cycle process?
If you have an internal billing department, it can be difficult to keep up with industry changes and increased volumes. Streamlining your existing process or implementing a more efficient billing solution will ensure that you are aligned with industry changes, maintain regulatory compliance, and improve your cash flow.
And in the current legislative environment, it’s more critical now than ever to optimize your RCM process and ensure that you are receiving the maximum possible reimbursements in the most timely manner. Let’s take a look at some of the areas where we commonly find opportunities for improvement.
Systems and process
Are systems scalable? Is it easy to make changes in-house? Are processes documented and adhered to? How much of your current process is (or can be) automated and done electronically?
TIP: Make sure your systems are flexible, nimble, and can handle ever-increasing volumes. Automate as much as possible, to reduce human error and processing delays.
Skills and resources
Is your billing team experienced in both FQHC and FFS billing? How do they stay updated with industry changes?
TIP: Employ billers and coders with FQHC experience, as they will know how to maximize the unique financial benefits available. Implement a training program that ensures staff remain current and encourages cross-skilling.
What is your denial rate and how do you measure it? Is there a trend of partial or full payment denial from specific payers or for particular services? How many claims have been submitted multiple times? Upon denial, how is a claim handled?
TIP: While the occasional denial is unavoidable, it is possible to significantly reduce them, which lowers the average days and amounts outstanding in your accounts receivable. Make sure your provider credentialing is accurate – this makes the difference between getting paid and not. Implement a robust claims review process to ensure that all claims are ‘clean’ and correct before submitting. The most profitable claim is one that is paid correctly, first time! When a rejection does occur, spend the time to investigate why before resubmitting, and brief everyone on how to avoid re-occurrence.
Are you receiving your maximum contracted rates? When was the last time you had a contract review?
TIP: Due to the complexity in health plans, a large percentage of providers are under-contracted. Consider engaging a consultant like ACE to review and assist when you negotiate or renegotiate your contracts, to ensure that you receive the best possible reimbursement rates.
Reporting & KPIs
Are you able to quickly access reports and track metrics? Are your metrics within or better than industry standards?
TIP: Implement systems that can provide accurate and timely reporting, and that will enable you to quickly identify and resolve any potential process issues. Make sure that your billing team understands and is aligned with your target Key Performance Indicators (KPIs).