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!

Leave a Reply

Your email address will not be published. Required fields are marked *

*