Optimizing Healthcare Revenue Cycle

Optimizing Healthcare Revenue Cycle Management

Front-end financial processes–eligibility verification, registration, and patient payment etc.—set the stage for the rest of the healthcare revenue cycle.

To remain competitive in today’s healthcare marketplace, physician practices must not only provide the best clinical care to their patients, but also optimize the way they manage the healthcare revenue cycle, making sure they preserve cash flow, limit bad debt and receive full reimbursement for services rendered. While most practices are comfortable focusing on clinical care, they struggle with revenue cycle processes—managing the business may not be a primary concern or strength for most physician practices.

Getting things “right” from the start

Front-end financial processes—eligibility verification, registration, patient payment and so on—set the stage for the rest of the healthcare revenue cycle. If an organization has strong front-end capabilities, then the back-end tends to flow more smoothly. As such, we aimed to make your upfront work as reliable, accurate and timely as possible, laying the groundwork for efficient billing and revenue capture.

For example, by automating eligibility verification, we decreased the number of denials due to lack of insurance. Using technology to check coverage proactively, we now know before the patient comes in the door whether he or she has insurance or whether we need to offer a form of financial counseling. It used to be that confirming eligibility was time-consuming and onerous, but the right technology makes this an easy and efficient way to reduce denial risk. Moreover, it puts our patients at ease, helping them understand their coverage parameters right from the start. Also we make sure you collect patient payments when required. If a patient does have a co-pay or deductible, collect that money upfront.

To ensure front-end processes consistently go according to plan, we provide regular staff training. For instance, walk staff through the different payer requirements, showing them each insurance card and talking about what to do when a patient presents with a certain type of insurance. Well-trained staff is key to effectively capturing patient information, verifying coverage and accepting payment, and make sure your staff have the tools they need to complete this successfully.

Outsourcing the back end

While many practices manage the front-end operations internally, the best practice is to outsource its payer billing efforts. If you want an effective and efficient back-end office you are better off to outsource it. Most practices find it challenging to keep up with all the changes in the field due to emerging technology, evolving regulations and shifting payer rules.

Outsourcing gives a practical alternative to keeping things in-house and allows practices to rely on an expert whose sole business is healthcare revenue cycle management. This frees you up to focus on expanding our practice and supporting providers in high-quality clinical care for patients.

Our company processes claims—amounting to millions dollars a year—electronically. To optimize claims submission, our company leverages technology with detailed front-end edits that proactively verify each claim houses the required information in the right place, reducing the number of rejections and denials and speeding cash flow.

We are also vigilant about denials management. Although there are fewer denials than ever before, they still occur and we have dedicated staff working them every day, clearing inventory within 48 hours. In addition to resolving specific problems, we track the kinds of denials that are occurring, looking for possible trends. If a pattern emerges, we research it to find the root cause and collaborate with our client partners to proactively resolve the issue. Many times this necessitates reaching out to the payer, which we do, due to our closer ties with insurance companies.

While practices can sometimes shy away from outsourcing healthcare revenue cycle management due to concerns around losing control of their revenue cycle, our clients have found the opposite to be true. We monitor your days in accounts receivable, denial turnaround time, and so on. Not only does this help us keep tabs on our performance but your performance as well. We have a collaborative relationship and if there are any issues to work through, we tackle them together.

Preparing for the future

As a result of its two-pronged approach to healthcare revenue cycle management, our clients have seen notable outcomes. We begin with a client their days in A/R are typically over 100. Within one year we consistently see rates of less than 20. We also have about a 99 percent collection rate.

In addition to stabilizing your financial operations, we are also building the foundation for future growth. Because of our strong front and back-end revenue cycle, your organization is more attractive to new providers and potential partners. Providers may come to you seeking membership because they see how we effectively manage both the clinical and business sides of the practice. This can allow you to expand your business and prepare for the coming changes in healthcare.