A Playbook to help you stabilize your hospital's A/R and Improve Cashflow.
By Kumar Shwetabh, Gautam Sivaraman, Sanjeev Britto, and Gayathri Natarajan.
While most hospitals, healthcare systems, and physician practices have dedicated in-house or outsourced teams working denials, they continue to see a steady rise in the percentage and the associated loss of revenue. The rising number of denials increases the cost to collect, delays cash realization, and sometimes even threatens the financial stability of the hospitals.
As reimbursements continue to decline and qualified labor is in short supply, healthcare organizations are looking at an increasingly challenging financial reality. Further, the rising consumerism is shifting the focus to improving the patient's experience, which requires significant investments in technologies for omnichannel patient contact tools.
Despite dedicated efforts to resolve A/R, the steady rise in claim denials is a mounting concern for hospitals, health systems, and physician practices. A review of denial and audit data can help providers prevent errors that lead to denials, and in the process, reduce financial loss and increase resource efficiency.
From scheduling patient appointments to denial resolution, each step in the revenue cycle must ensure data integrity to avoid claim denials and rework. This playbook looks at some of the strategies you can adopt to create value from your revenue cycle.
Top Strategies for denial management include:
Knowing the root cause and creating processes to plug the issues for the future
Understanding the issues in the front office - Referrals and Prior Authorization, Eligibility and benefits verification and self-pay and patient payments
Medical Coding Issues - systemic alerts on coding issues, the importance of provider education, and paying attention to pre-bill audits
Improving FPR in claims submission, and ensuring charge integrity - eliminating unbilled patient visits, resolving rejections to improve FPR, and ongoing analytics to reduce rejections
Revenue Optimization through A/R and denial management - Strategies include:
Invest in workflow software to optimize agent efficiency
Improving efficiency by tracking the number of touches to resolve, focusing on high dollar value claims, case escalation management,
Focus on 90+day A/R claims in a systematic manner
Running analytics to realign the focus of the A/R team
Focused teams on underpayment recovery
Achieving best-in-class A/R outcomes is not the function of the A/R team alone. It requires close coordination across all RCM functions. By deploying analytics and technology tools, you can channel your A/R team members' efforts to achieve collection goals and reduce wasteful follow-up efforts.
