When it comes to cash flow, health care providers often deal with issues unknown to other industries. Providing excellent service, expedited billing and powerful collection activities only covers a small portion of what drives excellent revenue cycle management. Doctors, clinics, hospitals and other providers must deal with insurance companies, claims filing and contract issues. Although 100 percent recovery in health care is almost unheard of, there are some best practices that can be used to increase collection efficiencies.
Documentation is a key component of collections for any provider. Insurance companies may request proof of medical necessity prior to claim payment or after the claim has been processed. Failure to produce adequate documentation can result in loss of payment. The best RCM organizations have detailed processes for obtaining and storing documentation.
Quality Claim Submission
Clean claims generate faster payment. This is especially true for offices that use electronic billing platforms. Payment floors on clean claims with some providers are as low as 14 days. The best claims software includes quality checks to ensure minimal mistakes in claim submission.
Timely Denial Work
One of the biggest challenges in most revenue cycle management offices is working payer denials in a timely manner. Failure to generate appeals or refile claims by payer imposed deadlines results in a total loss of payment. Developing efficient work flows for denials is essential to strong payer collections.
Any provider who has landed contracts with managed care organizations should not take their eye off the ball. These payers are notorious for paying incorrectly. When providers do not actively manage their contracts, they may receive lower payments due to system malfunctions with the payer. Periodic reviews of contract payments is a necessity to ensure full payment.
Not only is it a bad business practice to ignore the portion owed by a patient, it is also against federal regulations to waive copays without collection attempts. Amounts owed by patients may seem small, but as receivables add up, many organizations find their self-pay invoices account for 15 to 20 percent of aged AR.
The strongest revenue cycle management organizations address claims from the time service is rendered until payment is received. Small offices often outsource claim submission and collection to take advantage of others with RCM experience. No matter what quality and quantity of service is provided, a provider is only successful if money is collected.
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