Published by Pradip Sengupta, CEO of IPS Technology Services www.ipsts.com
As healthcare practices are transforming from fee-based services to outcome-based Accountable Care Organizations (ACO), they are facing unique challenges resulting out of a number of unknown factors due to new technologies, new processes and skills required to ensure maximum collection of revenue.
So how does a provider organization especially a practice make sure that it is collecting all revenue up to its potential that it deserves? Since the payers are demanding implementation of new healthcare technologies such as e-HR, Practice Management, HIPAA, Patient Portal, Interoperability, Data mining, etc. demanding improved process efficiency and quality, a physician’s practice needs to focus on leveraging technology better and thus maximizing revenue and profit.
Here are 13 tips categorized under People, Process, and Technology that will help a practice achieve its business and quality objectives:
- Process: Clearly understand and document the workflow to pinpoint and capture “all” service delivery points. Document and report to collect revenue. A significant number of providers ignore to document their processes (workflow) to find missed opportunities to collect revenue.
- Process: Capture all “required” data throughout multiple processes and aggregate them prior to sending bills the bills to the payer. More data you capture with adequate substantiation, the probability of increasing revenue goes up significantly.
- Process: Make every attempt to streamline the claims adjudication process is not streamlined. There could be multiple processes creating confusion, delays, and inconsistencies causing revenue collection problems.
- Process: Integrate all activities related to billing and collection with one well known and streamlined process and technology … the billing process could be integrated with a clearinghouse portal which will enhance visibility of unpaid bills and process efficiencies significantly.
- Process:Implement longitudinal healthcare process so that less time is spent to reenter data which could minimize errors and data loss which is fundamentally important for collection of revenue.
- Process: Avoid a mixture of manual, semi-automated, and automated processes with fax, Emails, Telephone, and web submission causing significant efficiency and lack of visibility. A small OB/GYN practice with 5 physicians/2 locations I consulted with recently was able to “discover” several hundreds of dollars of unpaid bills as well as reduce payment cycle time and increase cash flow by defining a consistent and efficient process.
- Technology:Avoid incorrect diagnoses (ICD)and procedure (CPT) codes which will increase rejections. Use a tool or a portal that will detect incorrect coding as much as possible. This will improve cash flow as payments will be made more promptly with less rejection.
- Technology: Use Computer Aided Coding or CAC technology to improve the efficiency of the billing process. CAC helps to automate coding and frees us a lot of time for the biller who can now act more like an auditor.
- Technology: Avoid using multiple software/systems (Practice Management, Billing, e-HR, etc.) and multiple billing services resulting into severe confusion. If you have to use it, you need to make sure they are integrated appropriately through a well thought out workflow.
- Technology: Document infrastructure and “how to” manuals adequately to avoid delays and creating negative impact on billing.