7 Best Practices to Reevaluate the Revenue Cycle
1. Verification. It's important to not verify too far in advance — three to five days is suggested. Establish a policy for benefit verification and make a list of questions for employees. Require employees document the payor representative they spoke with and at what time, as these phone calls are recorded and can be specifically referred to or drawn up if necessary. Call the patient and inform them of their estimated financial responsibility. "'Estimated' is the key word here. Make sure [patients] know it's estimated," said Ms. Sackos.
2. Admission. Verify registration information with patient and make corrections immediately. Reprint the demographic sheet. Copy or scan insurance cards front and back, as well as the patient's photo ID. Double check information entered into the software system. There's nothing worse than going to help somebody and the copy of the card is illegible, according to Ms. Sackos.
3. Managing outsourced tasks. Have a system in place to track operative report deficiency. For repeat offenders, it can be a quality reporting event. If there is no dictation within 48 hours, have the administrator call the surgeon. Also have a system in place to track pathology reports. Those should be received within 24 to 48 hours unless special testing is required, according to Ms. Sackos.
4. Coding and billing. Ensure you audit coding and billing at least annually for accuracy. You should have a benchmark in place for claims. For example, claims should be billed within 48 hours of the date of service. You should electronically file as much as possible, but the key is monitoring reports for errors after transmitting claims, according to Ms. Sackos. By monitoring, you can sometimes find that claims were never transmitted to payors. "If you're seeing a gap, maybe the claim was submitted on Monday and resent on Friday, you know there's a gap there and [staff] is not checking that on a daily basis," according to Ms. Sackos.
5. Claim follow-up. This is the most basic process for revenue cycle management but the one neglected the most, according to Ms. Sackos. One bad practice is cherry picking, where surgery centers only choose certain large claims to track down. "Initial follow up should occur no more than 15 days after submission of the claim," said Ms. Sackos. Subsequent follow up should then occur every seven days. "If the claim is still processing in a month, talk to a real person," said Ms. Sackos. "Then there is usually a problem."
6. Patient payment plans. Bill payment immediately after surgery, and aggressively monitor payment plans. Use service or obtain credit card information so payments can be automatically deducted per agreement. Call and speak with a patient if a payment is delinquent. "That's really important and really effective in getting your money," said Ms. Sackos.
7. Daily reconciliation. "There is nothing worse than the end of the month and you find out your staff wasn't reconciling daily," said Ms. Sackos. A process must occur daily where transactions in the surgery center's software for money collected for patient accounts are tied to the deposits made into the bank/accounting program.
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