With both reimbursement requirements and the solutions to manage them growing more complex, many practices may laugh at the notion of “streamlined” workflows in the office when it comes to their revenue cycle. Technology is supposed to help solve problems, after all, not add layers of technology that create more.
Practices making the most of the financial solutions in their office tend to do so by organizing their use into daily, weekly, and monthly activities. This sort of structure helps standardize office staff procedures and adopts the use of technology into existing procedures where it fits the best, minimizing staff disruption.
For example, your daily, weekly, and monthly revenue cycle management checklists may look something like this:
- Check eligibility for all patients
- Collect patient responsibility
- Perform coding edits
- Send claims
- Receive files (ERA, Claims status)
- Work rejections
A healthy revenue cycle starts with healthy daily processes, and your practice management system and clearinghouse can help you with those. Make sure you’re checking eligibility for every patient you see and collecting any balances owed. If you have access to patient responsibility estimation tools, use them. Eligibility helps you collect from their payer after the fact by ensuring you have accurate information. With the ongoing shift in cost burden to patients, when you lose an opportunity to keep those costs low you lose money. A professionally communicated policy to staff and patients about your up-front payment policies gives you a leg up on the most expensive payer party to collect from – the patients themselves. In addition, sending your claims, downloading your ERA files, and working your rejections on the daily ensures that you maintain accurate, up-to-date patient accounts and practice management system data, which is integral to your weekly and monthly activities.
- Analyze rejected claims reports
- Bill patient statements
- Manage reimbursements – timely filing, etc.
- Analyze contract compliance and denials and send out necessary appeals
You should be analyzing your rejected claims, denials, and contract compliance every single week. What are your most common reasons for rejection? Which payers deny you more than others? Why? Your practice management system and your clearinghouse can help you answer these questions and, since you’re managing your claims data on a daily basis, the answers you get will be meaningful. Use this information to improve your Daily Activities the week following. Also, you can’t forget about those patient payers – make sure, if you’ve got self-pay balances, you’re sending out those statements.
- Staff productivity reporting
- Transaction summary reporting – payers, time periods
- Performance reporting – month-to-month snapshot, days to file, top rejections
Your monthly activities are all about the big practice picture. How are your staff meeting their job requirements? Do they understand what they are supposed to do? Who’s doing what (or, who’s doing more than everyone else)? How did the practice as a whole do when compared to the month previous? How long is it taking you to get claims filed? These sorts of questions are more difficult to answer and more cumbersome to fix, but, if you’re managing your daily and weekly activities well, you’ll have the information you need to do so. Run your practice reports, utilize tools which can automate tasks and help you manage workloads, identify problem areas, and work with your staff on ways to improve them for next month.
Overall, it can be daunting to manage efficient processes in the practice amidst a busy day of seeing patients. But, if you can commit to appropriate sets of daily, weekly, and monthly activities, you can better ensure a clean revenue cycle and a happy, streamlined staff.