As Covid-19 volumes decline, health systems are rapidly moving to recover lost volumes and restart key projects. But while leaders are focused on revenue diversification and cost-cutting measures, many are overlooking the obvious: revenue cycle excellence.
Now more than ever, leaders must reign in uncollected co-pays, insufficient charge capture, and avoidable denials to ensure they are not leaving revenue on the table. But it can be difficult to determine where to direct your efforts.
To help get you started, we've outlined 10 key focus areas across all three parts of the revenue cycle. Use our tips below as a launch pad, then—for more specific, actionable tactics to improve performance in each of these areas—see our Revenue Cycle Resource Library.
- Before a patient receives a specific service, send a pre-service bill estimate so patients know their expected contribution. In addition, consider using automation to improve your insurance verification rate;
- Increasingly, patients do not make any point-of-service payment. Maximize the odds of getting fully payment by collecting at least 60% of the total patient obligation at point-of-service on the day of the appointment; and
- Never underestimate the power of patient financial counselors: They meet with patients to discuss their expected financial responsibility, payment plans, and their current insurance coverage. They can also ensure eligibility and registration are accurate to avoid potential denials.
Most health systems have inpatient clinical documentation integrity (CDI) programs—teams of coding professionals who translate a patient's condition into the correct codes. But simply having a CDI program isn't enough to reap the benefits. Organizations should also consider:
- Expanding their CDI program to the outpatient setting if they have the dedicated staff and a thorough understanding of Hierarchical Condition Categories; and
- Reducing charge drop rates by engaging clinicians in timely charge capture. By simplifying workflows and educating clinicians on the importance of charge capture, CDI teams can avoid badgering physicians about their documentation.
Even with a disciplined approach to front-end revenue cycle, organizations still face the looming threat of denials. In fact, the denial write-off rate for hospitals has risen 80% since 2011. To tackle this challenge, successful organizations:
- Track root-cause denials;
- Design customized EHR work queues;
- Use a pre-service review;
- Establish appeal escalation tiers; and
- Standardize their appeals process.
For more actionable denials tips and tricks, read about how Baptist Health achieved a 0.65% denial write-off rate.
Every organization will continue to face financial challenges as they recover from Covid-19. Improving collections, charge capture, and preventing denials are just a few ways to quicken this recovery.