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REVENUE CYCLE MANAGEMENT COURTESY CHECK

IDENTIFY AND SEIZE OPPORTUNITIES FOR IMPROVEMENT

Getting paid – timely and accurately – is one of the greatest challenges facing physician practices. Use this assessment to evaluate your revenue cycle process, and see if you discover more efficient and effective ways to improve cash flow.

Without automated processes and streamlined workflows, collecting maximum reimbursements from both patients and payers will continue to be difficult for many medical practices.
woman-checking-healthcare-benefits

VERIFYING ELIGIBILITY AND BENEFITS

There are different ways to confirm that the insurance information your patient provides is up-to-date and correct.
HOW DOES YOUR PRACTICE TYPICALLY VERIFY A PATIENT’S ELIGIBILITY AND BENEFITS?

You chose: answer.

  • Incorrect or missing eligibility information is the number one cause for denied claims.1
  • The typical cost of reworking a denied claim is $14.92.2
  • Manually verifying eligibility costs $6.83, while checking electronically costs just $0.22, a savings of $6.61 each.3

It’s clear to see that automating the eligibility verification process can make a significant impact on your practice’s bottom line

CHECK ANOTHER AREA OF YOUR
REVENUE CYCLE PROCESS.

SOURCE 1: The Top 3 Reasons Your Claims Get Denied, https://www.aapc.com/blog24089-the-top-3-reasons-your-claims-get-denied

SOURCE 2: Keegan, D. W., & Woodcock, E. W. (2015). The Physician Billing Process. Navigating Potholes on the Road to Getting Paid (3rd ed.). N.p.: Medical Group Management Association.

SOURCE 3: On average. 2013 U.S. Healthcare Efficiency Index, http://www.caqh.org/sites/default/files/explorations/index/report/2013Index.pdf

female-nurse-on-phone

AVOIDING DENIALS

Managing denials is a huge disruption to the revenue cycle workflow, as well as to a practice's bottom line. Each means costly staff time to research and appeal, and the potential for lost revenue.
DOES YOUR PRACTICE TYPICALLY REWORK EVERY DENIAL? IF NOT, WHY?

You chose: answer. Did you know that denials represent 90% of missed revenue opportunities?1 Avoiding denials in the first place is ideal. But when denials do occur, there are ways to simplify and automate the process.

  • Use tools that allow you to make real-time edits and corrections
  • Take advantage of routing mechanisms to assign claims rework to specific staff
  • Leverage pre-populated forms for timely filing and appeals letters

According to the Centers for Medicare and Medicaid Services, 65% of denied claims will never be paid in full. It's clear to see the negative impact denials can have on a practice's revenue.

CHECK ANOTHER AREA OF YOUR
REVENUE CYCLE PROCESS.

SOURCE: You Might Be losing Thousands of Dollars per Month in Unclean Claims. MGMA Connexion Feb. 2014

female-nurse-at-computer

REDUCING REJECTIONS

Managing the revenue cycle involves multiple workflows. One of the most tedious tasks is dealing with rejected claims.
HOW DOES YOUR PRACTICE MANAGE REJECTIONS?

You chose: answer. Reducing rejected claims is ideal, but when rejections do happen, automated workflows can help. Consider these:

  • Use tools that allow you to update entire batches of claims, as well as single claims
  • Automate your queues based on pre-defined profiles and/or on an ad-hoc basis
  • Assign tasks to specific billers to ensure faster resubmissions

It’s clear to see that automating the eligibility verification process can make a significant impact on your practice’s bottom line

CHECK ANOTHER AREA OF YOUR
REVENUE CYCLE PROCESS.
patient-paying-with-credit-card

COLLECTING PATIENT PAYMENTS

The percentage of a provider's revenue coming directly from patients is expected to
increase by 50% in the next 4 years.

SOURCE: Hospitals turn to friendlier tools to collect unpaid bills
http://www.modernhealthcare.com/article/20150516/MAGAZINE/305169974

HOW MANY WAYS CAN YOUR PATIENTS PAY FOR THEIR CARE?

You chose: answer. Offering your patients multiple options for paying their bills improves the patient experience and increases the likelihood that providers will be paid in full. Methods of payment should include:

  • In the office at the time of service
  • Online portal
  • Through the mail
  • Over the phone using interactive voice recognition technology

Nine out of 10 consumers want to pay their healthcare bills online.

CHECK ANOTHER AREA OF YOUR
REVENUE CYCLE PROCESS.

SOURCE: 7 statistics on healthcare consumer payment trends
http://www.beckersasc.com/asc-coding-billing-and-collections/7-statistics-on-healthcare-consumer-payment-trends.html

healthcare-professional-reviews-paperwork

MANAGING CLAIMS

It’s no secret – claims that are validated and scrubbed prior to submission typically get paid faster. Having an automated front-end process for submitting clean claims is a must for any provider office. Just as important is having dedicated workflows to identify and correct problematic claims quickly and easily. Without efficient front-end and back-end work-flows, you may be leaving money on the table.
WHICH OF YOUR CLAIMS MANAGEMENT PROCESSES ARE AUTOMATED?

You chose: answer. Tools that help you automate the claims submission process can:

  • Save you from countless hours spent on time-consuming resubmissions.
  • Identify gaps between submission and payment.
  • Increase cash flow by decreasing rejected claims.

Simple, faster claims submission with fewer rejections allows you to allocate staff to other, more productive tasks while
getting your practice paid faster.

CHECK ANOTHER AREA OF YOUR
REVENUE CYCLE PROCESS.
doctor-taking-notes

REPORTING AND METRICS

With the drastic changes in reimbursement models, it's more important than ever to be able to identify opportunities for revenue cycle improvements — before they negatively impact your bottom line.
HOW DO YOU TRACK AND REPORT ON TRENDS TO HELP WITH PROCESS IMPROVEMENTS?

You chose: answer. Sometimes small changes can make a big impact on your revenue stream. But the only way to identify opportunities for change is with actionable insight. You need to be able to:

  • Pinpoint issues or breakdowns in the claims workflows
  • Determine reasons for claim rejections
  • Establish clear paths to improve processes

Automated reporting lets you proactively address potential issues that could otherwise lead to a loss in revenue.

CHECK ANOTHER AREA OF YOUR
REVENUE CYCLE PROCESS.

SOURCE 1: The Top 3 Reasons Your Claims Get Denied, https://www.aapc.com/blog24089-the-top-3-reasons-your-claims-get-denied

SOURCE 2: Keegan, D. W., & Woodcock, E. W. (2015). The Physician Billing Process. Navigating Potholes on the Road to Getting Paid (3rd ed.). N.p.: Medical Group Management Association.

SOURCE 3: On average. 2013 U.S. Healthcare Efficiency Index, http://www.caqh.org/sites/default/files/explorations/index/report/2013Index.pdf

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