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!