Providers who want to improve their revenue cycle should follow the following five best practices, offered by SmartFund Medical, a complete revenue cycle management solution, for their coding, billing, and collections.
1. Educate patients on their share of costs upfront
As patients’ deductibles increase and more patients enroll in high-deductible health plans, healthcare providers will see more patients who will be forced to pay a significant portion of their healthcare costs out of pocket. As a result, healthcare providers should prepare for this change and work to educate patients about how much money they will owe for a procedure before the day of surgery.
“Set the expectation on the front end that they’re going to owe a balance. Patients, in general, want to pay for their share of the services. However, if you send them a bill for several thousand dollars in the mail 4-5 months after a surgery, the bill is unexpected and they may not have the means to pay it,” says Dennis Keaton, patient payment program manager for Smart- Fund Medical.
According to Jennifer McLeod, medical implementation manager, many providers try to avoid discussing costs upfront in fear that it will deter patients. However, she says that educating the patient upfront is one of the easiest ways that providers can improve their collections on the back-end.
2. Offer payment plans before services are rendered
After explaining to patients what they will owe, ASCs should offer payment plans before services are rendered. Payment plans allow patients to pay their out of- pocket expenses over time and budget for these expenses each month.
“With payment plans, patients are set up for defined payments. They are expecting the bill each month, and they can budget for it, along with their other monthly expenses, such as a car or house note,” says Mr. Keaton.
3. “Scrub” claims for errors before submitting
SmartFund Medical uses the phrase “scrubbing out claims” to describe their process of reviewing claims for errors before submitting them to payors. “Reviewing all claims for compliance issues, diagnosis issues and other possible coding errors greatly improves the chance of having a clean claim, which reduces days in A/R and increases your receivables,” says Ms. McLeod.
4. Monitor the status of claims
Many healthcare providers who outsource claims fail to monitor the status of individual claims and instead rely only on monthly statements to assess their revenue cycle. “When you’re turning over your billing and coding to a third party, sometimes you may not ever see a claim again until it shows up on a monthly statement,” says Casey Sullivan, marketing director. “Providers should try to find outsourced solutions that allow them to see the status of claims at any time they wish. This gives practices a much better idea about their cash flow.”
5. Don’t blame it on collections
Many healthcare providers are quick to blame poor collections processes for outstanding A/R. “In reality, however, issues with billing are usually the problem. If you have $500,000 in outstanding insurance A/R, you clearly have a billing problem,” says Mr. Keaton. “Providers can improve their revenue cycle by not denying the problem and begin to look at what’s going wrong on the billing side.”
The information provided should be utilized for educational purposes only. Facilities are ultimately responsible for verifying the reporting policies of individual commercial and MAC/FI carriers prior to claim submissions.
Ref: Becker's Healthcare
This post was first published November 11, 2009 and was updated July 29, 2022.