When it comes to revenue cycle management we’re all on the same mission: optimization! But how do you go about achieving healthcare revenue cycle optimization?
There are several things you can do internally to achieve healthcare revenue cycle optimization. The key is to have the appropriate staff on-hand with the proper level of expertise to help you manage coding, posting, denials, and more.
We highly recommend hiring an outsourced RCM partner because they have expertise and scalability you can’t always get from in-house staff. If you want more information on how an outsourced partner can help you, we’ve put together a resource that outlines 5 key benefits to consider. You can get that resource for free by clicking here.
In the meantime, here are a few tips to help you optimize your revenue cycle.
It goes without saying that accurate coding is the most sure-fire way to optimize your revenue cycle. Unfortunately this is often easier said than done. Accurate coding is dependent on a provider’s visit notes and a knowledgeable team to understand these notes and compliantly assign procedure and diagnosis codes
Additionally, coding accuracy isn’t just about submitting codes that aren’t denied, but about submitting a claim that will result in maximum reimbursement. Sometimes a subtle difference in coding can result in a big difference in your bottom line.
Compliance and coding go hand-in-hand. Maintaining compliance means you are using appropriate codes and updating coding methods as dictated by changes to laws and regulations. To ensure you are receiving maximum reimbursement and minimizing claims denials, it is critical you remain up to date with changing regulations and are able to quickly adapt your coding accordingly.
Optimizing your revenue cycle can also be achieved through the speed in which you are able to submit claims, manage denials or carrier requests for more information, and how quickly you bill patients for the portion of services for which they are responsible. If you manage your revenue cycle in-house, a team member on vacation or out of the office can cause you to have a backlog of claims.k. Additionally, surges in patient numbers due to COVID variants or other seasonal illnesses (cold, flu) can also increase your claim load and increase the time between when a patient is seen, claims are submitted, patients are billed, and payments are received.
As important to coding as compliance is, ensuring that physicians tell a complete story in their charts and notes can help coders to be more accurate. Ask physicians to be detailed and specific in their visit notesc. For example, a doctor could say “sharp pain in the upper right abdomen” instead of “stomach pain.” Additionally, having coders with expertise in your specific area of medicine can be extremely helpful in translating physician notes into accurate codes that will optimize your revenue cycle.
Claims and Denials Management
Despite a coder’s best efforts and expertise, denials or carrier requests for more information are inevitable. For many practices, keeping up with daily claims filing is enough to fill each day. Unfortunately that means there is a shortage of resources available to respond to carriers that request more information from the physician, facility, or patient. When these requests are unanswered, your revenue cycle will suffer. Likewise, without proper resources to manage denials, you will not receive any reimbursement for the services you provide. Dedicating time and resources to claims and denials management is critical to optimizing your healthcare revenue cycle.
There are many reasons why you could receive a denial or low pay response from a carrier. For emergency departments and physicians, this is a rather common occurrence. Knowing how to respond and having the bandwidth to do so are critical to optimizing your revenue cycle. We’ve put together a helpful resource for emergency departments and physicians with tips on how to respond to denials or low pay in the ED. You can download that resource here: https://www.gryphonhc.com/emergency-medicine/
Mediation and Arbitration
There are regulations and laws on the side of healthcare providers that insurance carriers must follow. Unfortunately, there are times when the carriers don’t follow the law, or push the boundaries with the belief that you will not fight back due to the resources required to do so. While legal fees and staff resources are a consideration, if you believe you are not being reimbursed appropriately, having legal experts on your team to fight the carriers when the law is not being followed will help you maximize reimbursement.
If you’d like more information about how Gryphon Healthcare can help your practice achieve healthcare revenue cycle optimization, schedule a call with us! We’ll put you in touch with our team of experts and start optimizing your revenue cycle right away.