In the world of healthcare revenue cycle management (RCM), practices are losing revenue due to simply not having the time and diligence it takes to reconcile and review their revenue cycle process. Leaving money on the table is the last thing you want to do, so here are three areas that the RCM team at SMSC consistently performs. These three key elements are crucial to ensuring financial stability and efficiency for your practice:
1. Charge interface reconciliation. This important step in the revenue cycle process helps confirm that all services provided to patients have been billed. Billing interfaces are typically established and programmed to load into billing systems, so a solid reconciliation process of all billable services is key to keeping a healthy cash flow. We recommend reviewing your interface often – monthly or more – because hospital IT specialists can make changes to the EHR and overlook updating the charge interface. For example, an SMSC client created a new department for mammography services. The interface team overlooked adding the new department to the file causing the billable charges to be missed. These missing mammography charges would have been a considerable loss of revenue if we hadn’t caught the error. If services are not reconciled on a regular basis, it could cause delays in receiving revenue and sometimes even revenue loss due to filing limits with payors.
2. Allowable monitoring. This is the practice of auditing paid claims against the contracted rates with payors. Payor contracts can be very complicated and if the rates are not loaded accurately within the adjudication systems providers can lose revenue. It may seem minor for a claim to be underpaid by a few dollars, but when you couple this with months/years of underpayment it can add up to a significant amount of revenue to the practice. When analyzing this data, it is important to find the root cause of the underpayments. Change in contract rates, administrative errors, claims submission can all be causes for underpayments. Appealing individual underpaid claims is important; however, trending and identifying the issue on a larger scale can speed up communication and settlement with payors.
3. Denial management. Unpaid claims require constant review. The best way for a practice to avoid denials is to ensure there is an accurate claim submission process that follows payor polices. While many denials can be appealed and paid it is still crucial to find and correct the root cause of the problem. Denial management could include several practices, such as improving your registration process to make sure all insurance information is correct. CPT/ICD coding with appropriate modifiers is critical to submitting a clean claim. Checking eligibility and obtaining authorizations prior to procedures will also highly reduce the risk of denial. Understanding payor policies and coverage will help in consistently submitting clean claims and ensuring your practice is thoroughly paid for services in the quickest and most efficient way possible.
Revenue cycle management takes a considerable amount of time, diligence, and knowledge of payor policy, but is unequivocally worth it for the financial gain. By managing your revenue cycle with these three key factors in mind, your practice will be positioned to recover a significant amount of revenue. If your practice could benefit from consistent reconciliation and review of your revenue cycle, reach out to Patty Frechette directly to learn more about how we can support your practice.