Hospitals continue to experience extraordinary financial pressures with continued rising costs in labor, drugs, and supplies. According to a recent AHA report, hospital expenses increased by 17.5% between 2019-2022 while Medicare reimbursement increased by a mere 7.5%.
Accordingly, it is no surprise that the Advis team is contacted frequently by providers seeking solutions related to optimizing billing and rev cycle management processes.
Providers often ask the same questions in various forms: Are we capturing everything efficiently and accurately? What is causing the delay in reimbursement? Are we missing revenue opportunities? Why is there such a lag between full payment and discharge?
Here are the Top Strategies, in order of commonality:
- Commercial Contract Updates. Assess the status of existing Commercial Payer Contracts. Often, it’s been years since the last time some payer contracts were reviewed for potential revision of rates, carve outs and other negotiable terms. Review, negotiate and implement a schedule for a regular assessment process. Perhaps your hospital offers specialized services in demand in that community that may not have been considered at the last time the contracts were negotiated. It’s important to emphasize the importance of your services to the payer’s population to negotiate an optimum rate.
- Clear Collection Communication. A transparent communication process with a patient from the beginning (whenever possible) is an ideal way to create a financial plan for the stay or service provided. Discuss and hopefully collect patient responsibility at the earliest point possible. Provide an estimate of the cost prior to the provision of care, whenever possible. Patients do not like surprises and tend to work with the provider a lot more efficiently, if they understand their financial obligation and the expectation for payment from the beginning.
- Accurate and Up to Date Provider Enrollment and Credentialing. There should be a clear process for onboarding practitioners and new practice locations to ensure that the payers have ample time to process necessary filings. Understanding the enrollment/credentialing requirements for a provider or new practice location is vital to ensure providers do not start providing care before they are in network or properly enrolled with that payer. A qualified team handling enrollment/credentialing is very important to prevent delays in claim processing based on a pending credentialing application or lacking authorization to file a claim.
- Clear and Accurate Billing. Do not overcomplicate your invoices. Sending an accurate invoice to a patient that is easy to navigate will be more likely to be paid right away than an invoice that requires a discussion with your billing team.
- Make it Easy. Paying a bill should be easy and clear with various options on how to pay. The patient is a savvy consumer and prefers to handle payments with a few clicks whenever possible. Take advantage of all of the new technology available to assist a patient with paying a bill.
- Invest in Qualified Staff. Hiring staff that are not experienced or perhaps not qualified for a specific provider type like a SNF or a Hospital may cost thousands of dollars (sometimes millions) while they learn on the job.
- Staff Engagement & Training. Assess staff competence regularly to ensure they understand the nuances behind provider specific billing and collection practices. Offer ongoing refresher training and certification programs to billers and AR teams. Staff training and access to education, certifications and updates from government payers and commercial payers alike. Staying up to date with claim processing, rule changes and system updates is necessary to reduce chances of claim processing delays.
- Outsourcing: Staffing shortages and finding qualified staff in rural or remote locations is a challenge for many providers. When hiring a qualified team with specific expertise with the provider type in question is difficult, it may be more prudent to outsource provider enrollment/credentialing, coding, billing and collections by experts in each of these fields.
- Efficient Process for Denials and Appeals. A billing team should address denials and partial denials swiftly and accurately to ensure timely handling. If appeals are necessary, a clear process should be in place with a clear follow-up procedure including frequency of contacts and documentation of activity. It is up to the provider to stay on top of pending MAC/Payer reviews or pending appeals. If you are lucky enough to reach a reliable and helpful contact with the payer or MAC, keep their contact information close and ready to utilize whenever attention is needed. Going through the various customer helplines can be a time-consuming, grueling and unsatisfactory way to receive reliable assistance.
- Listserv/training Registration. Ensure your coding, billing and finance teams sign up for appropriate list servs that apply to the scope of their work. Your jurisdiction’s Medicare Administrative Contract or MAC offers listservs related to coding updates, local coverage determinations and troubleshooting with RTPs, denials or rejections. They also offer tutorials, training webinars and tips on Medicare claim coding and processing/cost report preparation/submission. HRSA and the OIG also have listserv registration for coding alerts, grant opportunities, webinars and updates. Often, preventable claim processing delays are avoided by alerts sent by your MAC.
We are happy to address questions or assist with billing, coding, enrollment and revenue cycle management optimization needs. Please contact your Advis consultant directly, contact the Advis headquarters at 708-478-7030 or Monica Hon at mhon@advis.com
Published: May 1, 2024
