Impact Insights

Are Your Revenue Cycle Processes Working Optimally?

Jill Berger-Fiffy

A recent survey from the American College of Healthcare Executives (ACHE) of Chief Financial Officers (CFO’s) names “financial challenges” as their largest worry with revenue cycle management (cash flow) being a major concern. With that in mind, a comprehensive review of the Revenue Cycle could be prudent to ensure your system and team are working optimally.

Such reviews commonly encompass the three-legged stool approach; people, process and technology, and require a review that includes a comparison to best practices. The findings and recommendations can help you eliminate barriers and reveal opportunities within the Revenue Cycle.

Confirm best practice workflows are in use for Pre-access services:

  • Utilize the scheduling automation features to maximize availability for providers in all locations. Allow staff to schedule across locations to ease the process for patients.
  • Offer multiple vehicles for patients to secure an appointment. Examples include centralized phone numbers, web-based scheduling and robot assistance, app or patient portal.
  • Ensure the front-end process includes insurance verification (real-time and batched overnight) and eligibility, prior authorization, collection of co-payments and deductibles at the time of service, and interfaces for add-on technologies that push information to billing and worklists.
  • Collect prior balances from patients when they are in the office. Offer scripting for staff and a call to the patient prior to the visit. Summarize the call and the plan for the balance in a visible location (i.e. comments or scheduling notes) for the Patient Access team.
  • Provide patient estimates for out-of-pocket expenses prior to rendering the service.
  • Consider if a transition to centralized, decentralized or hybrid processes would be advantageous for the pre-access services.

Confirm best practice workflows are in use for Professional Billing process:

  • Expand access to charity care and statewide Medicaid by reviewing all registered self-pay patients prior to scheduling and/or date of service. Utilize financial counselors to enroll patients in presumptive Medicaid or provide an estimate and develop a payment plan.
  • Ensure policy and procedures provide clear direction for task completion and an escalation process for barriers and opportunities.
  • Use automation to reduce human touches. Examples of automation include sending claims, correcting edits, coding guidelines and appeal workflows.
  • Reduce charge lag with clear timelines and consequences for late charge submission. Collaborate with clinical leadership to reduce/eliminate deficiencies.
  • Utilize dashboards and reporting within your practice management system. Drill down both at a high and a detailed level. Compare the performance to nationally recommended benchmarks.

It’s important to step out of the day-to-day and take a strategic look within your organization.  Process improvement offers opportunities to make changes and increase cash flow!

2 thoughts on “Are Your Revenue Cycle Processes Working Optimally?

  1. Avatar Medwave says:

    Great content Jill.

    IMO, maintaining a 45-day or less revenue cycle management is important in keeping a steady flow of cash for any business.

    Increasingly physicians, clinics, hospitals and health care providers are accepting patients who have health insurance instead of collecting payment directly from the patient using their services. However, some of the health insurance claims of these organizations and professionals are being denied by the insurance companies or only partly paid. Since the costs of providing health care is increasing, the profit margins of medical providers is adversely affected when insurance claims are denied. Accounts receivables (A/R) recovery is one of the most effective ways an organization can use to recover the amount due for health care services provided.

  2. Data suggests that many hospitals find it increasingly difficult to scale and guarantee high revenue cycle performance. As we all know, hospitals and healthcare providers have a large number of expenses. It’s crucial that they receive prompt patient payments from insurance companies, etc. It’s vital for all healthcare departments to work together to meet revenue goals. If a provider has become financially successful, there’s a reason for it. It’s extremely important to attribute which protocol(s) works and why, to ensure the optimal execution of a revenue cycle.

    One of the many reasons healthcare providers face financial crisis, revenue cycle success is unattainable due to roadblocks. They have to focus on the movable roadblocks, clearing the path for prosperity and gain. It’s paramount for providers to focus on the various components within their revenue cycle such as scheduling, patient registration and eligibility checks, upfront patient collection, claims management and medical billing and patient collections.

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