As we all know, a hospital’s billing process can be a complicated one. There’s the collection of patient info, the submission of charges to the payer and patient (which entails the preparation of insurance claims and patient bills), and the recording of charges, payments, adjustments, and write-offs.
Additionally, you may also have employees who focus on helping patients understand their accounts, on resolving billing, on monitoring, and on following up on accounts receivable.
Long story short, it’s a complicated process that can easily become inefficient or slow over time, if it isn’t regularly assessed.
So, in order to prevent that from that happening at your hospital or health system, here’s a list of 7 questions to ask about your organization’s revenue cycle, which will help you gauge its efficiency, and keep you on the right track!
1. How simple is your claims process?
This is a great place to start your questioning. Are you currently using an external claims clearinghouse to manage your claims process? This oftentimes results in delays or a lack of transparency on whether a claim is received, accepted, or rejected by insurance companies. Or, on the other hand, have you adopted in-house software that automates your claims process? This can give you both the transparency into the current status of your claims and a faster turnaround time for your reimbursements, as your claims don’t have to go through a third party.
2. Are your claims clean?
Next, after taking a look at your overall claims process, take a look at all of your rejected claims individually. Where do you find the mistakes on the claims that are causing them to be rejected? Does it have something to do with the coding? And as a follow-up, are the coding mistakes occurring because of a manual coding error or because of a mistake in your Health Information System (HIS)?
3. How often do you examine the revenue cycle?
If you’re answer is “every now and then,” you may be in some trouble. By allowing your operations go to on autopilot, you run the risk of rejected claims piling up without you knowing. You may also miss out on some unclaimed revenue. It’s important to remember that documentation demands change—ICD-10 is set to come out this October, for example, which will require adjustments to some coding. You may want to consider setting an examination schedule that keeps you on track in assessing your collections and revenue cycle to ensure that you stay on top of your game.
4. Do you use trends and benchmark data in your examinations?
By considering historical trends in your monitoring, you’ll be able to see more easily where improvements can be made. Can they be made in your coding processes? In your billing? In your engagement with insurance companies, Medicare, or Medicaid? Using certain types of content management tools makes this analysis easily accessible. Additionally, if your organization is a member of HFMA, you can access its MAP (Measure, Apply, Perform) initiative, which allows you to see industry benchmarks and recommended revenue cycle standards.
5. Do you educate and work with your staff?
This will also help prevent any sort of coding mishaps. By engaging with your staff, and showing them how to code, bill, and collect correctly, you will help ensure data accuracy on your claims, which will reduce the number of rejected claims you see. Keeping your staff up-to-date on changes in documentation requirements and patient accounts will also help maintain billing efficiency.
6. Do you ask your frontline staff for suggestions?
In addition to educating and working with your staff, are you also engaging them on this level? Do you ask them how they think problems or roadblocks can be solved? What errors or mistakes do they come across on a regular basis? Asking your frontline will not only give you great insights from the people with the most hands-on experience, but it will also promote recurring involvement and sustainable change in your organization.
7. What processes and tools do you use to improve efficiency?
There are a number of different processes and tools you can implement into your organization, and some are more effective than others. For example, do you have an Enterprise Content Management system? Do you use any sort of digitalized content management tools? These typically allow you to reduce processing time in a number of different departments. It’s also important to consider the organizational structure of your hospital: For instance, are desks organized in an optimized layout for easy flow of information? Some hospitals even adopt lean six sigma, which is used in the automotive industry to cut out waste—could this be effective at your organization?
Of course, these questions are only the beginning. As you ask and answer these, you’ll surely find more and more areas where you can make improvements, which will ultimately contribute to a more efficient revenue cycle for your organization.