All it takes is one misstep – overlooking something in eligibility verification, under- or over-coding, making a seemingly innocuous data entry error when filing a claim, or not following up on a denied submission – to stem the flow of revenue.
Enter modern data and analytics tools. It is easier than ever before to precisely and accurately manage the revenue process, from first contact with a patient to the final receipt of payment.
Automating pre-appointment functions, such as eligibility verification and pre-authorization checks with a modern practice manager (PM) saves time, reduces the rate of administrative error and, most importantly, improves the likelihood that you'll receive payment for services rendered. This process is important for new patient onboarding and ongoing management of patient relationships (e.g., properly documenting changes in an insurance plan).
Front-desk staff can also use cutting-edge PM solutions to let patients update key data, such as demographic information, via an online portal. While this information may seem inconsequential, an incorrect address in a claim is all it takes to solicit a rejection. Pre-appointment and patient-registration tasks effectively kick-start the RCM lifecycle. A single misstep here could make the difference between getting paid and writing off the services of your highly-skilled providers.
Your front-desk personnel can facilitate more complete payments from patients, either before or after services are rendered. Upon eligibility verification, your staff can generate a payment estimation based on the patient's deductible and co-pay values. They can then present this estimation to patients prior to the appointment, so that patients can pay ahead of time via an equipped portal or, at the very least, be better prepared to make payment at the point of service. Either way, empowering patients with an understanding of their responsibilities BEFORE services are provided can greatly improve both the efficiencies and the bottom line of your revenue process.
Precise documentation of patient encounters is crucial to submitting accurate claims. A best-in-class Electronic Health Record (EHR) system that focuses on your specialty’s unique diagnoses and procedures will make this process easier by automatically suggesting and linking to ICD and CPT codes based on clinical notes. This will help clinicians quickly and accurately document patient encounters with the proper treatments codes. It also highlights coding opportunities that clinicians may otherwise miss, which reduces under-coding – whether done intentionally out of fear of a future audit or accidentally.
Following all of this methodical work, the final phase of RCM is to create, submit and follow up on claims. An intelligent PM assists with this process by comparing manually-entered claims data to the patient information on file, which helps to prevent a simple typo or out-of-date patient address from causing a rejection. This claims-scrubbing process helps prevent you from stumbling on the last leg of RCM. At long last, you can submit your claim.
If, despite everything, a claim is rejected, it's important to route that denial to the proper parties for efficient handling. Again, this is something that a cutting-edge PM tool with intelligent workflow handling will do automatically.
More importantly, though, it's vital that you actually have the staff and the resources to perform denial management functions. Otherwise, your backlog of denied claims will slowly but surely amass over time, until you're left with many thousands of dollars of revenue stuck in limbo or, worse yet, written off altogether.