Healthcare is one of few industries where services are not paid for when they are received. Typically one party such as a doctor or hospital provides services to a secondary party, the patient. A third party such as a health insurance or liability carrier are often involved in facilitating financial reimbursement for the services provided. Money keeps the practice in business. Each phase of the revenue cycle is important, from payer contracts to charge capture and collections. Below are ten ways to efficiently manage the revenue cycle and how to maximize potential revenue.
Review Payer Contracts: It is important to know what you are agreeing to when you sign any contract. Be sure you know and understand the expected reimbursement and contractual allowances before you sign.
Know the Prompt Payment Law: Most states have this in place, where payers must pay or deny a clean claim within 30-45 days of receipt. While the definition of a clean claim could be disputed, no response from a payer within the 30 to 45 day window should result in immediate follow up.
Clean Claims = Fewer Denials: Education is the key to clean claims. Providers, front desk, billers and clinical staff all contribute to the information that is submitted on a claim. Each individual needs to understand how their role impacts claim payment.
Respond Promptly to Claim Denials: Denied claims should be addressed daily as they are received.
Review Payments Carefully: Payers will often make mistakes when processing claims that need to be appealed for proper reimbursement. The person posting payments must pay attention and question anything that does not look right.
Appeal Claims Paid in Error: Any services paid incorrectly should be appealed immediately.
Don’t Get Frustrated, Get Help! Do not hesitate to contact the payer if you question any denials or payments that do not look quite right. They will be able to tell you what is needed in the appeal to overturn the denial or wrong payment.
Patient Balances: Contracted providers are obligated to collect the co-pay at the time of service. Failure to do so could be a breach of contract. Staff members working at check-in and check-out should be comfortable asking for payment.
Hire and Retain the Best Employees: Generating revenue is the most important task in the financial success of the medical office. The people hired for these roles should be seen as an investment. Ongoing training is critical to their success as the rules and regulations are constantly changing.
Monitor Benchmarks and Key Performance Indicators: Benchmarks and key performance indicators should be reviewed monthly. Let your billers know what is expected so they can monitor and achieve the goals.
Every employee is valuable and should take responsibility for their role in the practice thus helping the revenue cycle to be clean and efficient.