Unlocking Revenue Cycle Potential: 3 Strategies to Optimize Accuracy, Speed, and Reimbursement for ASCs
According to new research by Bain & Company and KLAS, over 95% of healthcare providers are looking to invest in new revenue cycle processes to boost productivity and automate tasks within the 2023 calendar year ¹. As surgical organizations look to improve overall revenue integrity, it’s important to identify the best ways to leverage technology to optimize the revenue cycle.
Here are our top three revenue cycle strategies that deliver the fastest, greatest return on investment:
1. Obtain Accurate Documentation Upfront
Claim delays and denials can often be traced back to common errors within manual, front-end processes such as patient demographics, insurance verification and eligibility, as well as the approval process for prior authorizations.
In fact, research has shown that half of all denials within the US hospital system are due to front-end revenue cycle issues, with the top cause stemming from inaccurate patient registration and eligibility ².
Manual data entry, such as entering patient demographics, transcription, and coding, leaves significant room for error within each claim, plus the hidden costs involved with addressing those errors has largely contributed to the average cost per revenue cycle transaction, which has increased by 55% since 2018³.
Improving the accuracy of your documentation, starting with how you enter patient demographics, will increase the accuracy of charge capture and complex claims. Front-end automation can cut down on manual process errors and flag discrepancies including dates and locations of service, healthcare provider details, codes, and prior authorization information.
The right tools can also integrate payer policy updates to ensure compliance with state and federal guidelines and avoid denials and delays in reimbursement.
2. Submit Clean Claims Quickly
According to a study by the Medical Group Management Association, the average administrative cost to rework a denied claim is $25 per claim and more than half of all denied claims are never reworked ⁴. Notably, surgical specialties such as orthopedics where the reimbursement per case tends to be higher than other medical specialties, the financial implications are even more exorbitant.
An efficient transcription solution will increase the speed and accuracy of your claims while easing the administrative burden of creating operative notes for physicians and their staff alike.
Be sure the dictation process is as easy-to-use as possible, and there are ways to identify and complete any missing dictations and signatures that can often end up delaying the billing process. In some cases, physicians can dictate from a mobile app where they’re also able to manage multiple locations and bulk-sign multiple reports at once.
When adding transcription to your revenue cycle workflow, be sure the integration is seamless to avoid unnecessary delays. If the transcription solution can sync with your scheduling software and EHR/EMR system, you can auto-fill patient demographics and automate the delivery of reports. Transcription that includes web-based management allows you to track, view, edit, print, search, and e-sign documents from any location to expedite your facility’s claim submission and reimbursement process in real-time.
Once the dictation is received, the report should be transcribed and ready for coding and billing within 24 hours. If your revenue cycle partner offers both transcription and coding solutions tailored to your organization’s medical specialty, cases can be coded within hours of delivering the operative note. The ability to turn around error-free reports and accurate medical coding quickly will improve the overall timing and reimbursement of your entire revenue cycle.
3. Streamline Billing & Collections
Once a claim has been coded and submitted, it can be easy to lose track of the status. Following up on your in-progress claims can be complicated and often requires exceptional attention to detail. Many surgical facilities outsource their billing and overall revenue cycle management to better organize, track, and follow up on pending claims.
The latest trend in Accounts Receivable departments is using automation and machine learning to follow up on claims and rework claim denials to improve the rate of collections. This technology provides accounts receivable specialists with detailed summaries to address specific claim issues, thereby improving the speed and accuracy of the claims resolution process.
When choosing a revenue cycle management company, it is important to enquire about examples of revenue improvement from current clients. Optimizing the accuracy of the revenue cycle starts with integrating front-end services, transcription, and coding into one workflow with your billing and collections process. A total end-to-end revenue cycle management approach ensures greater accuracy and improved cash flow.
By relying on the surgical expertise of one RCM company to integrate front-end services, transcription, and coding to capture and maximize all reimbursement opportunities for your surgery center, clinic, anesthesia group, or surgical hospital, you can distribute more time and staff resources to enhance your patient experience and grow your business.
Are you looking for ways to improve your revenue cycle management? Take the first step towards optimizing your revenue cycle process by requesting a revenue assessment from our team of RCM experts. Request a demo.
Resources:
- 2022 Healthcare Provider IT Report: Post-Pandemic Investment Priorities. Bain. https://www.bain.com/insights/2022-healthcare-provider-it-report-post-pandemic-investment-priorities/
- Paavola, A. (n.d.). 86% of denials are potentially avoidable: Strategies to better prevent, manage denials. www.beckershospitalreview.com.https://www.beckershospitalreview.com/finance/86-of-denials-are-potentially-avoidable-strategies-to-better-prevent-manage-denials.html
- Marting, R. (2015). The Cure for Claims Denials. Family Practice Management, 22(2),7–10.
https://www.aafp.org/pubs/fpm/issues/2015/0300/p7.html#:~:text=A%20study%20by%20the%20Medical - Working Together: Advances in Automation During Unprecedented Times 2021 CAQH INDEX ® 2 • 2021 CAQH Index 2 0 2 1 C A Q H I N D E X Working Together: Advances in Automation During Unprecedented Times. (n.d.). https://www.caqh.org/sites/default/files/explorations/index/2021-caqh-index.pdf