Revenue Cycle Top 10 Process Improvement Efforts


April 10, 2014
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Each month, Wipfli’s Revenue Cycle team contributes insights to the Health Care Perspective newsletter highlighting the Top 10 Revenue Cycle Opportunities we observe from our work with clients. This month’s insight pertains to Revenue Cycle process issues we often find can be improved. You can perform a quick checkup for your organization by ensuring the answer to each item is “yes.”
 
1) Do you have a Revenue Cycle Team in place? This team is crucial for facilitating communication throughout all areas of the revenue cycle. Interdepartmental communication is the key to a highly functioning, successful revenue cycle.
 
2) Do you have the right staff doing the right task at the right time? Take time to review current revenue cycle processes (registration, charge capture, claims processing, A/R follow-up, etc.) to identify wasted steps, avoidable errors, long lag times, etc. This will improve your metrics (e.g., A/R days, denials, net collections, and lost charges).
 
3) Do you have a strong point-of-service collections process? Start with detailed policy and procedures to clarify expectations. Include scripts to help staff be consistent with their message. For example, it helps to state, “How will you be paying for your copay today?” versus “Would you like to pay for your copay today?”
 
4) Do you have departmental charge capture policies and procedures? Outlining charge capture procedures within revenue-generating departments creates accountability and staff awareness. These documents can also double as a charge capture training manual for new staff entering the department.
 
5) Is your chargemaster reviewed regularly? The chargemaster should be reviewed annually, at a minimum, but quarterly is better to coincide with the AMA and CMS updates. Changes need to be communicated to appropriate departments and staff to ensure proper charge capture and compliant billing practices.
 
6) Does your provider schedule template include regular, consistent appointment slots? Standard time slots allow for more efficient provider scheduling and better patient throughput. A template also assists scheduling staff to easily and quickly identify open appointments so the patient’s experience is better.  
 
7) Do you benchmark and trend key performance indicators? Benchmarking and trending data highlights areas where you have potential to improve; trending will point out when something is broken within the revenue cycle.
 
8) Do you actively monitor your payer contracts? Contracts should be reviewed annually and renegotiated as needed. Avoid evergreen contracts, which can pay you the same amounts for years! Actual reimbursement amounts should be compared to contractual rates to ensure you’re getting the reimbursement you expect.
 
9) Is your registration staff collecting all pertinent patient information accurately? Registration errors cause the largest volume of claims processing and payment issues for the billing office. Fixing the process that causes these errors from the source will alleviate rework on the back end, leading to better, clean claims rates, faster payments, and a far more efficient revenue cycle team.   
 
10) Does your facility have a formal denials management/elimination process? This provides the data that helps you move the focus from post-service, inefficient work (e.g., repeatedly following up on claims, processing repeating denials) to fixing the issues at the source, or the root cause, of the denial, thus eliminating the denial problem altogether.

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