In the past, revenue cycle management largely boiled down to claims submission and payment receipt. Today, revenue cycle management is much more complex. It includes a full-circle billing cycle and requires thoughtful processes to optimize everything from credentialing and chart capture to patient engagement and KPI (Key Performance Indicators) reporting. Every step in the cycle influences your group’s compliance with standards, claims denials, efficiency, and cash flow.
The list of variables influencing emergency medicine revenue cycle grows each day. As groups are challenged to do more with less and margins thin, revenue cycle management is a critical part of emergency medicine group resiliency. Considering the many nuances of emergency department revenue cycle, it can be challenging to determine where to focus resources. In this post, we share three fundamental areas to prioritize to ensure your revenue cycle is optimized to improve collections, patient experience, and efficiency.
1. Think Outside of Billing to Address Revenue Leakage
Reducing revenue leakage requires revenue cycle management optimization strategies beyond billing and collections (though those remain important). Ensure your strategy also includes a focus on credentialing, chart capture, eligibility, provider documentation, coding errors, and patient pay. These are a few best practices to keep in mind:
Dedicate Resources to your Credentialing Process
Optimizing the process of contracting and provider enrollment with payers is an often-overlooked revenue boosting opportunity. We find that when we help groups focus on improving their credentialing processes, most see a 1-5% increase in cash flow. This increase is because many groups leave money on the table when providers are not credentialed by government and private payers in a timely manner, or providers let their credentials lapse.
Since the credentialing process can take up to 4 months, delays in the process significantly impact cash flow. However, there is an alternative. Your group can reduce billing delays and denials associated with credentialing issues by dedicating proactive staff resources to managing credentialing for all the government and private payers you work with. This individual or third-party partner can keep provider credentials up to date, track each payer’s renewal schedule, obtain national provider identifier (NPI) numbers, and address and prevent any credentialing-related claims denials. When you have an expert dedicated to this process, the time to credential is often considerably condensed (sometimes to 3-4 weeks rather than 3-4 months). This shorter timeline means fewer delays and reduced revenue leakage overall.
Optimize Chart Capture
Appropriate and complete physician documentation impacts not only patient care (by facilitating patient care decisions, reducing treatment errors, and informing provider resource allocation) but also whether your group will be reimbursed appropriately for the actual level of care delivered.
Provider documentation is often incomplete, delayed, unclear, or illegible. While providers are busy delivering patient care, it is common for provider charts to be left open– and incomplete at the end of the shift. When this incomplete data is pushed through to the revenue cycle management feed it is often submitted in incomplete form. Preventing this is a valuable place to focus. Your revenue cycle management partner should have technology and processes in place to audit chart capture and screen for incomplete data before the claim is submitted. Make sure you have this review safety valve in place to prevent denials due to incomplete information.
In addition to screening for incomplete data, a system of communicating with providers and a process for rectifying these deficiencies needs to be in place. This process may include personalized follow-up and education with providers regarding documentation errors as well as data-driven chart auditing procedures that flag documentation issues.
Streamline Insurance Verification
It is valuable for your hospital, group, and revenue cycle management partner to work in tandem to ensure complete demographic and insurance information is collected for each patient. A fantastic opportunity area to improve cashflow is to ensure you have a strong process in place to get demographic and insurance information from urgent or emergent patients for which information was not gathered upon admission to the ED. Additionally, it is valuable to ensure your revenue cycle management partner does not take the information your hospital and group provides at face value. Rather, they should have a collaborative interface with your registration office and a secondary process in place to verify that the insurance and demographic information is accurate and complete before billing the patient.
2. Leverage Technology Across all RCM Processes – Especially AR/Denial Management
If you have not reviewed each aspect of your revenue cycle and considered where technology would increase efficiency and performance, you are missing opportunities to streamline operations and realize more revenue. A literature review in JAMA found that our nation’s healthcare system wastes $265.6 billion per year on administrative complexity such as complex billing and coding processes. Technology can help change that.
Since technology adoption accelerated during COVID-19, healthcare providers are increasingly investing in technology and automation that will reduce complexity and operational costs in the long term. In 2020, Gartner reported that 50% of U.S. healthcare providers would invest in robotic process automation (RPA) by 2023 to optimize overall costs and scarce resources due to COVID-19. RPA, artificial intelligence (AI), and other innovative technologies are valuable to efficiently flag revenue cycle errors and trends, streamline tedious processes, and optimize critical revenue cycle management functions such as denials management.
Though there are innumerable applications for technology and automation to improve revenue cycle (some of which we have mentioned in the other two sections of this post), the most valuable area we recommend implementing it is in your accounts receivable/denial management process. Denials are a common revenue leakage point (with 1 in 10 submitted claims being denied by both commercial and public payers, resulting in a loss of up to 2% revenue). Knowing this, ask your revenue cycle management partner if they can leverage technology to track payer behavior, identify payment issues, and prioritize workflow to handle denials and manage payment issues in a timely manner.
Your partner should review payer responses by place of service, complaint, diagnosis, day of week, time of week, by available bed or room, and by provider. Analyzing this data can flag patterns impacting denials or reimbursement. Visibility into data trends showing reasons for denials by payer can help your team pinpoint strategies to prevent future denials.
Technology can also streamline the denial resolution process by quickly sorting denials by type—controllable denials (e.g., things that can be fixed and resubmitted like incomplete information) and uncontrollable denials (e.g., an uncovered service that the patient must be billed for). Denial management is much more efficient when you have a dashboard that sorts uncontrollable and controllable denials. This enables your team to focus resources where they can make a measurable difference in denial reduction.
3. Invest in a Robust Patient Engagement Strategy
It is likely that patient satisfaction and engagement are already primary pillars of your quality improvement efforts. We suggest going beyond prioritizing patient engagement and satisfaction when it comes to patient care and making it a revenue cycle management priority as well. Patient engagement and satisfaction are crucial revenue cycle management priorities because patients are responsible for more of their healthcare costs than ever. Since the roll out of the Affordable Care Act accelerated adoption of high deductible health plans, patient responsibility has steadily risen. With this shift, healthcare providers have struggled to collect patient payments. Changing this requires that healthcare providers and revenue cycle management companies be creative and utilize technology to understand patient preferences and simplify patient payment processes.
Consider your patients’ experience with billing as part of overall patient experience. This includes everything from educating patients on their coverage and the bills they will receive to the bill payment process and the customer support your billing partner provides. Overall, the billing process influences your patient reviews, patient satisfaction scores, and collections. Below are just two of the items we suggest incorporating into your patient engagement strategy to boost patient collections:
- Make it easy for patients to pay their bill. Offer multiple methods of payment (online, over the phone, by card, by check)—make it simple for the patient to pay their bill on their terms. These options should be integrated into your patient engagement plan and leverage text messages, email, phone calls, and print mail. Increasingly, patients expect a digital billing experience from healthcare service providers. Additionally, they prefer to have options such as payment plans that they are accustomed to having for other goods and services outside of healthcare.
- Establish a patient advocacy team. Dedicate resources to educating patients on their coverage, the billing process, and their options for payment. This effort should include reviewing messaging on each communication touch point throughout the process from patient statements to support call center scripts based on each category of patient need and each specific payer.
Revenue Cycle Best Practices Improve Cash Flow, Efficiency, and Patient Care
Thinking outside of billing and collections to address revenue leakage, leveraging technology throughout your revenue cycle, and investing in patient engagement are three primary areas to improve your emergency medicine group’s revenue cycle management performance. Choose a revenue cycle management partner who prioritizes these three areas to set your group up for revenue cycle success.
How Resolv Healthcare Can Help You Optimize your Revenue Cycle Management Improvement Efforts
Resolv Healthcare, a Harris Revenue Cycle Business, is a leading provider of technology-driven solutions that transform the patient experience and financial performance for healthcare organizations. Resolv provides revenue cycle management solutions for hospitals and hospital-based provider groups, ambulatory practices, laboratory practices, dental practices, and worker’s compensation and personal injury providers. Learn more about how Resolv’s 25+ years of emergency medicine revenue cycle management experience, innovative technology, and dedication to patient engagement can help improve your group’s patient experience, efficiency, and cash flow. Book your free consultation with Resolv today.
About the Author
Chandy Hanna, CHBME, CHCO, Vice President of Operations, Resolv Healthcare
Chandy Hanna is a senior executive with more than 20 years in the finance and healthcare industries. Since 2004, Chandy has worked in hospital and hospital-based provider revenue cycle management operations. She oversees proper operational controls, administrative and reporting procedures, and people in place to effectively grow the organization and to safeguard financial strength and operational efficiencies.
She is a Certified Healthcare Business & Management Executive (CHBME) through the Healthcare Business Management Association. In addition, Chandy is a distinguished Certified HIPAA Compliance Officer (CHCO) through the American Institute of Healthcare Compliance, Inc.