Maintaining business continuity and achieving financial goals are significant challenges for healthcare organizations. Revenue cycle management (RCM) plays a pivotal role in addressing these challenges by ensuring that administrative and financial processes are efficient and effective.
By leveraging medical billing expertise, healthcare providers can simplify billing, identify new revenue opportunities, and maintain the financial health of their practice. Optimizing these processes allows providers to focus more on delivering quality patient care.
Below are some of the best practices that healthcare providers can adopt to enhance their revenue cycle management:
Charge Posting: Ensuring Accuracy and Compliance
Before charge posting, ensure that credentialing is complete for each provider, accurate patient demographic and insurance information is obtained, and eligibility and benefits are verified. Securing prior authorization and completing any necessary advance beneficiary notices (ABNs) are also critical steps.
When readying the charges, verify that documents are signed by the provider, confirm all necessary ICD-10, CPT, and HCPCS codes and modifiers are provided and valid, and gather additional required data such as National Drug Code (NDC), Digital Object Identifier (DOI), and last menstrual period (LMP).
During charge posting, adherence to payer coding rules, use of internal scrubbers for clean claims, and timely resolution of coding concerns are crucial. Regular reporting on same-day collections, pending charges, charge lag, visit counts, unsigned progress notes, and charges posted helps maintain accuracy.
Submission Management: Streamlining the Claims Process
For submission management, utilizing internal and third-party scrubbers to identify and resolve issues before claims submission is a necessity. Reviewing and releasing holds ensures smooth pre-claim submissions.
Submitting electronic claims requires completing electronic data interchange (EDI) enrollment and verifying successful transmission from the system. For paper claims, it is important to include prior payer’s explanation of benefits for secondary and tertiary claims, verify payer addresses, and opt for electronic submission when available.
Submission follow-up involves reconciling electronic batches to the clearinghouse, promptly resolving rejections, and identifying trends for proactive resolution. Key reporting metrics include pre-submission errors, holds and pending submissions, billed claims report, claim acceptance rate, and rejection rates and trends.
Payment Posting: Ensuring Timely and Accurate Payments
Prior to payment posting, electing for electronic remittance advice (ERA), establishing payer portal access, and reconciling remittance documents with bank statements are necessary preparations.
Posting payments accurately, securely storing explanations of benefits (EOBs), and promptly transacting virtual credit card payments are important steps. Opting for electronic funds transfer (EFT) over virtual credit cards ensures efficiency. Additionally, timely posting of capitation adjustments and appropriate application of additional payments such as bonuses or rebates are vital.
Managing Insurance Accounts Receivables
Managing insurance accounts receivables involves timely follow-up on delinquent and denied claims, understanding payer-specific requirements, and using payer portals for efficient resolution. Submitting requested documents only as necessary and adhering to provider manuals are key practices.
Corrected claims and appeals require collaboration with providers to correct coding issues and following payer guidelines for submissions and appeals. Evaluating denial trends, implementing proactive solutions, and adjusting strategies as needed are crucial for trend identification and resolution. Reporting should focus on clean claim rates, days in accounts receivable (A/R), aging A/R analysis, and financial summaries.
Managing Patient Accounts Receivables
Managing patient accounts receivables involves writing off small balances, handling accounts for deceased patients and bankruptcies appropriately, and applying unapplied credits correctly. Flagging accounts for unique financial situations such as discounts or charity is important.
Processing statements weekly, sending collection letters as necessary, and stopping patient statements when the collection process begins are critical steps. Setting up payment plans for large balances and ensuring regular reporting on collections and returned mail are essential for efficient management.
Partnering for Success
Greenway Revenue Services (GRS) offers the expertise and resources needed to achieve revenue cycle excellence. By partnering with GRS, healthcare organizations can simplify billing, identify new revenue opportunities, and ensure financial health. Success lies in a comprehensive approach that combines best practices, expert consultation, and continuous monitoring and adjustment of strategies. To learn more about enhancing your revenue cycle management, click here.
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