Efficient and profitable revenue cycle management is accomplished through daily scheduled tasks, ongoing auditing and quality reviews. Having staff work in specialization areas with cross training creates an environment of expertise, not guessing. Bringing it all together with technology is the only way to make it happen in the detail oriented and fast-paced world of health care. Outsource Receivables has the proprietary technology and workflows to make it happen. Here are just a few of the focus areas to consider:
- Billing task queues: Relying on the nuances of different practice management or electronic medical records systems is merely settling for a second rate approach. ORI has developed customized queues to track each specialty area to ensure efficiency and accountability for staff and workflow turn around timelines. Having visible queues allows workflow managers to shift production for staff vacations or peak periods.
- Payments and posting workflow: Payments entered into the billing system must be posted to patient accounts within 48 hours. Having money that is not applied to patient accounts is unacceptable and will impact every area of accounts management. ORI manages a daily deposits process with a proprietary payment posting and reporting tools to ensure an efficient and timely daily workflow. In addition, the system manages all incoming correspondence which is critical to effectively working accounts. Knowing where you are at for any given point in the month allows accurate measures of staff performance on accounts and systems as well as a gauge for when overtime may be warranted.
- Daily reporting and dashboards: Many independent practices hear that their staff are overwhelmed and can’t accomplish what they are expected to do on a daily basis – but how do you really know what metrics to measure against and when an additional staff person is warranted? Moreover, what is an average day of payments, posting, aging, customer service, and what does good (or bad) look like? Having staff and workflow processes that are measured against benchmarks on a daily basis is a non negotiable priority. Knowing where your statistics should be day-to-day allows issues to be surfaced immediately when there is a problem with a staff person, something broken at the clearinghouse, or your technology is down in a given area.
- Patient responsibility collections: One of the biggest gaps in independent medical practices is a lack of consistency with statements, phone calls and collections notices. Without timely, accurate and documented attempts to collect patient balances customer service staff lose confidence and unpaid accounts go out past 90 days or more. Also, it is a waste of time and money to continue to send outstanding patient balances to bad addresses. Reviewing and resolving returned mail will ensure balances are paid or go to collections. Patient accounts must be audited monthly against consistent standards and a quality checklist to keep the revenue cycle moving and allow confidence in customer service interactions with patients on outstanding balances. ORI offers a monthly auditing process of patient accounts that ensures every patient receives 3 statements, 2 phone calls, and a collections letter before being recommended for collections. Skip tracing is conducted on all returned mail to ensure the most reliable and accurate information is used for the account. While there are always accounts that will be sent to collections, the timely processing and turnover will lead to greater success and higher recovery even for collections accounts.
- Resolving rejected and denied insurance claims: Strategy on rejections and aging accounts can’t be left up to staff to determine individually. Without a clear daily team approach and accounting of outstanding rejects and denials, the practice aging will quickly climb to dangerous levels. Let the accounts lag and you will soon face timely filing deadlines and ultimately thousands in lost revenue. The first step is daily working of rejections and providing feedback to front end staff on common issues to keep your workflow efficient. Getting rejections worked correctly the first time around requires that staff have the ability to share common issues they see with the various insurances. Feedback can also be implemented into EMR, practice management and clearinghouse setup to prevent future rejections. Managing denials in a timely fashion is one of the most important areas for maximizing revenue. Again, sharing information across staff is critical for staying on top of ever changing dynamics. ORI has a daily “huddle” which is a short but effective way to share information across staff and departments and ensure issues do not go unresolved. ORI trains staff for specialization on denials and provides daily worklists that optimize how accounts are worked by organizing payors and denial types. For tougher accounts that require phone calls and appeals to the payor, staff are able to use technology workflows to group similar accounts and address all at once for efficiency.
- Accounts maintenance and monitoring: Missed charges are lost opportunities for revenue and maximizing coding is key to success. Having EMR and PM systems with separate checks and balances allow accurate accounting of visits and charges across systems. Many systems have nooks and crannies that need to be checked on a regular basis to ensure charges have been coded and sent for all visits. Lastly, keeping patient credits, small balance write-offs and insurance credits in order will ensure a clean system and accurate aging across accounts. ORI utilizes robust processes and workflow technology to ensure each step in the process is monitored and validated, from charges and coding right through to collections.
Truly efficient revenue cycle is achieved when the daily reports, dashboards, huddles and auditing are brought together to provide front desk and billing staff feedback that can reduce the overall rejections and denials and increase reimbursement. Here are just a few:
- A regular audit of top payor rejection reasons can help identify and correct front end issues related to demographic collection and coding
- Denials feedback and education for optimal documentation and coding can go a long way towards efficiency on the back end that can have a substantial return for payments
- Charge lag time between visit and charge entry will tell you a lot about where the bottleneck is and specific providers or coders who are not maintaining agreed upon timelines of 48 hours on average
- Analyzing days of service outstanding and accounts receivables shows whether you are improving or going backwards and must be used as part of staff performance indicators
ORI manages systems, staff and processes for peak efficiency on a quarterly basis:
- System training and updates for staff to ensure new features are understood and utilized properly
- Reviewing which payors are still sending paper checks provides staff a list for electronic funds transfer requests to remove the check processing step from the workflow
- Removal of outdated codes, modifiers, reference tables etc. from PM and EMR systems
- Install regular system updates and project management custom software improvement requests with vendors
- Auditing visits for coding compliance
- Removal of inactive user profiles
- Annual fee schedule updates
- Audit system back-up and downtime plans for risk management
Efficient and profitable revenue cycle management is ORI’s core responsibility and business. Many practices outsource because they find they just can’t be experts in all the areas required. Having a team and a collaborative partner to work with can take your billing office from good to great. ORI understands it is a big decision to outsource and assists with the vetting process and on-boarding for a win-win outcome. Moreover, ORI guarantees are applied to every contract to make the transition and billing accountable with financial penalties for not meeting goals. Outsource Receivables, Inc. guarantees and promises are possible because of the consistency of processes and the proprietary technology and workflows that make it all happen.