Cash flow can be impacted by numerous revenue cycle issues. The complexity of the hospital revenue cycle, involving various stakeholders, often obscures the origin of cash flow problems, which usually have multiple contributing factors. Identifying where things go off track in the revenue cycle is essential for maintaining financial health.
Revenue cycle problems can be challenging to pinpoint.
To address these issues effectively, it’s crucial to examine the financial, operational, and technical aspects of the revenue cycle both individually and collectively. One effective method is to divide the revenue cycle into phases, allowing for a more focused assessment.
Segmenting Your Revenue Cycle
Breaking down the revenue cycle into distinct phases can help manage and resolve issues more systematically. While these phases are interconnected, evaluating them separately can prevent you from feeling overwhelmed. Consider segmenting your revenue cycle into:
- Registration and patient financial clearance
- Medical coding
- Claims submission
- Claims rejections and denials
Enhance the Registration and Financial Clearance Process
Pre-appointment tasks, such as verifying insurance eligibility, coverage limitations, and any special requirements like pre-certifications, can streamline medical accounting tasks later on. Using the right software to interact with payers can provide insights into how much the insurer will cover and the patient’s financial responsibility. Collecting co-pays upon patient sign-in further simplifies the process.
Implementing a comprehensive financial clearance process can significantly optimize your revenue cycle. PracticePath’s process intelligence and automation solutions can automate insurance verifications and eligibility checks, reducing administrative burdens and ensuring patients are aware of their financial obligations from the start.
Improve Coding Accuracy
Comparing your coding practices to benchmarks, such as those from the Centers for Medicare and Medicaid Services (CMS), can reveal potential issues before they disrupt cash flow. Regular coding audits by external experts can ensure accuracy and proper reimbursement for services provided.
Consulting with a coding expert can enhance accuracy. PracticePath’s business intelligence and process automation solutions offer real-time coding validation that integrates seamlessly with existing systems, reducing errors that lead to claim rejections.
Monitor and Improve Clean Claims Rate
Understanding how many claims are returned due to inaccuracies or incompleteness is crucial for improving reimbursement rates. While some software packages can track clean claims, manual tracking may also be necessary. Strive for a clean claims rate of at least 90% to maintain steady cash flow and minimize the time accounts spend in receivables. Analyzing rejected and denied claims can help formulate strategies to address these issues.
PracticePath’s actionable data analytics can monitor your clean claims rate, providing insights for necessary improvements. Maintaining a high clean claims rate enhances cash flow and reduces receivables duration.
Address Claim Rejections and Denials
Rejected claims are often due to simple errors like misspelled names or incorrect ID numbers, emphasizing the need for up-to-date insurance ID information. Denied claims, deemed “unpayable” usually due to medical necessity questions, can often be appealed successfully. Identifying patterns in rejected and denied claims can highlight issues with specific insurers or submission specialists.
Utilize PracticePath’s business intelligence solutions to identify common causes of claim denials and implement corrective actions. Automated denial tracking and appeal processes can significantly reduce unpayable claims and enhance overall reimbursement rates.
Conclusion
Medical accounting, as part of a complex revenue cycle, involves multiple stakeholders, making problem identification challenging. By breaking down the cycle into manageable phases and evaluating each, you can address issues systematically. PracticePath’s comprehensive solutions for process intelligence, process automation, business intelligence, and actionable data analytics can streamline your revenue cycle processes, ultimately improving cash flow and financial health.
Leveraging PracticePath’s innovative solutions enables healthcare providers to effectively tackle revenue cycle challenges and ensure sustained financial performance.