Having trouble keeping up with claims? A/R days quickly adding up? Overwhelmed by denials? There are solutions for these. We know back-end functions of a business office are complex, so we're here to share a few tips to make it more manageable.
Claims Submissions and Edit Resolution:
- Submit claims daily – Submitting new claims every day helps you avoid timely filing denials.
- Work edits within 24 hours – Put a process in place to identify coding or charge entry mistakes before claims are sent to decrease avoidable denials.
- Maintain best practice training – Dedicate time to train staff so they are familiar with the claims process and edits. Knowledgeable staff can find mistakes and correct them before claims are submitted.
- Automate as much as possible – Automation minimizes errors, leading to accurate payment posting and overall profitability.
- Identify individual line denials – When posting adjustments and denials, make sure to note individual line details to make follow-up more efficient.
- Be mindful of secondary and tertiary payers – Double check there are no errors with the primary payment which could lead to secondary and tertiary payers getting claims filed with mistakes.
Credit Balances and Refund Processing:
- Implement a proactive strategy – Work credits and issue refunds regularly to prevent them from accumulating. Refunds should be issued within 60 days to prevent patient confusion and hassle.
- Consider system automation to apply patient credits to other services – Automatically applying credit balances to other services where appropriate cuts down on staff time needed to identify credit balances.
Denial Resolution and Underpayment Analysis:
- Organize claims by denial type – Separate claims into preventable denials and those that need to be managed upon occurrence.
- Understand patterns – Determine if there is missing or inaccurate information leading to denials.
- Leverage technology – Load fee schedules to automatically identify any variance by payers.
Customer Service and Patient Pay:
- Create a patient pay process and schedule – Establish productive contact points to meet your patients’ unique needs. Use data to determine which patients can pay without multiple contact points to save time and resources.
- Set consistent expectations and benchmarks for patient-facing staff – Training your patient representatives is the first step in a positive patient experience. Be transparent about goals and regularly check in to make sure your staff feels supported.
So there you have it – a checklist with tactics for improving your revenue cycle performance. Some tactics you can take action on today; others can be entrusted to a revenue cycle partner. Interested in outsourcing some or all of your revenue cycle operations? We can help.