How Quality Health Information Impacts Your Bottom Line
HIM and Patient Billing are Key Players in Your Revenue Cycle
Revenue cycle management in your healthcare practice starts long before the patient steps foot in the exam room. Successful revenue cycle management strategies focus on front-end tasks that lead to successful insurance claim reimbursement or early out medical bill collections.
The quality of the health information your front desk collects and records is of utmost importance in maximizing reimbursement and preventing AR days. Any errors carry through the revenue cycle and disrupt insurance reimbursement and self-pay payments.
All Hands Touch Your Revenue Cycle
Medical coders and patient billing representatives are not the sole drivers of your revenue cycle. Healthcare revenue cycle management actually begins the moment a patient calls to make their appointment and ends when all claims and payments are processed and the account balance drops to zero. Every hand in your medical practice touches your patient accounts, starting with your scheduler.
Your administrative staff is responsible for establishing a patient account and verifying insurance eligibility. Pre-registration tasks include detailing insurance coverages and collecting a relevant medical history. Mistakes made here could result in an automatic insurance claim denial.
When a patient’s appointment is complete, your practice will file an insurance claim using the proper ICD-10 code, which directly represents how much money you’re eligible for reimbursement. The wrong code will cause a claim denial or an incorrect reimbursement rate. The medical provider also must complete charge capture duties, which documents services and translates them into billable fees.
The claim is then sent to the payer for reimbursement. Behind the scenes, your staff posts payments, processes patient account statements, performs collections duties, and handles claim denials.
When the insurance company evaluates the claim, they determine how much they’ll reimburse, if anything. Your practice may then be able to collect the remainder of the balance that insurance doesn’t cover directly from the patient.
Revenue cycles in most any other industry are quick, when money is exchanged for goods and services. However, in healthcare, you can only complete the revenue cycle after a claim is reimbursed, which can take quite a long while. As you know, claims can go back and forth for months until an agreeable resolution is reached. And for accounts with balances for which patients are responsible, you may not be able to collect payments in full, depending on a patient’s financial status.
Managing the process takes significant resource allocation, and with low reimbursements and decreased patient volumes, medical practices and hospitals must be smart with their staffing. Often, a more cost-effective solution for managing the revenue cycle is not necessarily employing a full billing staff, but hiring an EBO like Assistentcy to handle it for you.
Claims Denials Are Common
Claims denials are growing in frequency due to federal agencies fighting healthcare fraud and abuse. Medicare Part A claim denials increased by 12.5 percent and Medicare Part B claim denials increased by 9 percent in recent years, as the feds target improper Medicare payments and reduce overpayments.
Hospitals and medical practices can avoid claims denials by training staff on completing health information management tasks, tracking claims throughout the process, and fully investigating denials.
Tips for Successful Revenue Cycle Management
- Verify insurance eligibility during pre-registration for procedures or tests. Never be caught off-guard when an insurance company will not reimburse. The most common reason claims are denied is due to eligibility issues.
- Proactively manage claim denials. Work within your organization to develop procedures for resolving reimbursement issues, or hire an EBO like Assistentcy to do it for you.
- Rely on data to manage your revenue cycle. Reporting on quality care, patient satisfaction, and healthcare costs can help you to identify and address gaps in your process. The robust reports you receive from Assistentcy can help you make important organizational decisions that maximize profit.
- Collect payments from patients at the time of service, before the patient leaves the office, when possible, without putting undue financial pressure on patients.
- Invest in training employees on proper coding, chart documentation, and financial policies. The return on investment is measurable.
Assistentcy Helps You Manage Health Information and Patient Accounts
Working with a medical billing company like Assistentcy takes the pressure off your front office, patient billing, and coding teams. Our early-out approach to patient billing has been shown to increase collections, while reducing the overall cost to collect.
Assistentcy ensures hands-on revenue cycle management from day one, so you can dedicate your time to medical care, rather than finances. We’ll deliver fewer AR days, increased revenue, and on-time patient payments through our early-out services, helping you avoid medical bill collections altogether.
We know how to motivate slow-patient self-pay patient accounts and assume the responsibility of after-insurance accounts and the costs associated with AR processes, like credit card fees, postage, and statement and letter printing.