It is imperative to implement an effective system for revenue cycle management and follow better claim billing practices to improve your practice’s bottom line in 2015. According to the 2014 Black Book Survey, 87 percent of small and community hospitals expect declining to negative profitability in 2015 owing to lower reimbursement, unrecovered collections and inefficient billing and records technology. So, the practices need a system built to make most out the advanced technology to get smarter over time as well as adjust to changing rules and requirements of payers. They should also aggressively collect the money owed by payers and patients (self-pay). Here are some tips to overcome these challenges and enhance your profit.
Areas Where You Should Invest
You should invest in the following areas to ensure an effective revenue cycle management system that keeps up with the changes in 2015.
- ICD-10 Transition – As the ICD-10 implementation date is approaching, you must invest in comprehensive training for your staffs, material costs for training, practice time for coding in the new system to avoid claim denials and huge revenue loss.
- Compliance Plan – Develop a formal, written compliance plan to avoid the risk of audits and recoupment. Physicians can team up with local practices of similar size and specialty to prepare a list of vulnerabilities and set up a plan to address those vulnerabilities. Frequently updated Survey is a great resource for practices to create plans. The OIG also offers guidance on developing compliance plans.
- Meaningful Use – From 2015, eligible professionals who do not successfully demonstrate meaningful use will be subjected to a payment adjustment or simply reduction in payment. The reduction starts at 1%, increases each year that an eligible professional fails to demonstrate meaningful use and the maximum penalty is 5%. To avoid penalty, evaluate whether your EHR meets your expectations and enables your progress towards Meaningful Use.
- Internal Audits – As the U.S. healthcare system is moving to ICD-10 coding system this year, it is very important for physician practices to carry out proactive audits regarding coding and documentation quality in order to avoid a decline expected in coder and physician productivity while implementing the new system.
- Certified Coders – If there is a lack of non-credentialed coders, physicians will continue undergoing billing and documentation scrutiny by external auditors. Hiring a certified coder will help prevent denials and costly recoupment.
- Non-physician Practitioners – As patients are flocking to healthcare facilities since the inception of the Affordable Care Act (ACA), hiring non-physician practitioners (NPPs) will be useful to manage the practice well and increase profit. The Medical Group Management Association published a report titled NPP utilization in the future of US Healthcare, which is useful to find out how to recruit and retain an NPP, whether a full-time or part-time contract would be appropriate and more.
- Marketing – As the ACA brings in new business for your practice, marketing your practice via a website or social media can help establish your brand and lead to long-term success.
Getting Paid for Your Services
Even if you have implemented all these strategies, the effects of payer traps or patients’ unwillingness to pay can prevent you from getting your claims paid. Here are some effective strategies to avoid that.
- Perform an A/R Review – Claims can be missed, denied, under/overpaid or simply lost. So, it is quite important to review your A/R accounts routinely and reconcile your charges against the payer explanation of benefits (EOB).
- Follow Up on Payer Fee Schedule – Knowing your fee schedules for each major payer is vital to receive maximum reimbursement for your services. Most practice management systems allow practices to upload payer fee schedule so that it is possible to automatically compare money received to contracted reimbursement rates.
- Efficient Claim Denial Management – There should be an efficient claim denial management system that works consistently with claim denials. This will help to follow up with every denial, find out the real reasons, take necessary actions including filing an appeal or sending refund requests appropriately.
- Review Payer Contracts – Reviewing payer contracts and the end date can confirm whether coverage exists for your services and avoid claim denials.
- Educate Patients – Working closely with patients and educating them on their insurance plans, especially new exchange plans will protect you from the patient’s refusal to pay for your service. Set up a policy that lets patients know you will collect all co-pays and deductibles at the time of service and create a payment process for patients having high deductible coverage.
- Implement Collection Strategies – Pre-verify the coverage for all patients several weeks before their appointments. Give special attention to high-cost procedures that may fall under patient deductible.
Though these tips will help to grow a thriving healthcare practice, producing the maximum revenue possible with minimal fixed or overhead cost remains a challenge. To overcome that challenge, the practice requires a partner with expertise and resources to make sure a claim is completely, accurately and quickly adjudicated to maintain steady revenue and reduce days in A/R. A reliable medical billing and coding company offers the service of certified professionals and web-based advanced technology to efficiently process claims.