5 Proven Strategies To Improve Patient Engagement and Revenue Cycle Efficiency

It is a strange paradox. As the healthcare industry transitions towards integrated, cost-effective business models, the revenue cycle of medical practices, has become more fragmented and expensive.

Payer reimbursement cuts, drastic increase in consumer payments and regulatory changes are challenging traditional, antiquated approaches to revenue cycle management. According to a survey by PwC, one in two, Americans, rate hospitals poorly, for affordability of services and price transparency.

To survive in the New Health Economy care providers should focus on patient care. But there are bills to be paid to keep the lights on! Fortunately, a healthy revenue cycle and good patient care needn’t be mutually exclusive terms any more. There are ways to build a strong and sustainable revenue cycle while still focusing on patient care. Here are five ways healthcare organizations can stay successful in the consumer directed healthcare environment.

5 ways you can drive up patient engagement and revenue cycle efficiency at your medical practice!

1. One in four claims are rejected due to insurance eligibility errors and incomplete information.

Discuss with your patients about insurance details, coverage limitations and treatment options prior to their appointment. Maintaining a friendly relationship with patients will enable you to collect accurate eligibility information.

St. Luke’s hospital was able to increase collections by placing calls to patients, prior to their visit, and discuss price estimates. This system has helped the hospital in educating patients about their financial responsibility and has increased net collections.

2. Improve the patient billing experience. Straight out of a can patient statements and sporadic follow-up calls won’t work. Financially engaging patients is vital in the post-reform climate. High deductible health plans are posing a huge challenge to care providers. Explain the patient billing process and payment options before care begins and simplify the transaction as much as possible.

Create patient statements that are unified. Translate complex codes into plain language
Add financial details outside the episode of care such as co-pays and deductibles
Discuss the financial responsibility of patients for high-value, pre-scheduled procedures.
Provide payment options according to the convenience of patients. Offer several payment options such as net banking, cheque, credit card or internet banking.
Offer different payment plans and educate patients on the same
Create a financial assistance policy and a collaborative process built around your patient needs

3. Tired of handling no-shows? According to MGMA, medical practices experience an annual no-show rate of 5-8%. At an average of $150 per appointment the amount of dollars lost, can add up to thousands every year.

Shoot a mail or talk to patients during their next appointment about how inconvenient no-shows are. Case in point.
A physician group, based in Minnesota was struggling with no-shows and appointment scheduling inefficiencies. A personal mail by the provider to patients, who didn’t turn up, did the trick. The physician group was able to decrease no-shows and increase patient volume significantly.
Sending remainder mails decrease non-attendance rates by as much as 36%, a study by the Internet Journal of Healthcare, states.
Some medical practices reward patients who show up on time and offer a small discounts as well. By giving out small rewards to patients, healthcare organizations can not only reduce the number of no-shows but also build a loyal patient base.

4. Do you know that the possibility of collecting payment drops to 40% once the patient leaves your practice? Physician practices collect just 60% of patient co-payments.

Train patient access staff to collect more at the front-desk. In the current environment medical practices cannot afford to be lax about patient financials.

A San Diego based healthcare provider installed 27 kiosks across its 11 clinics. The kiosks were put up to increase patient engagement. The surprise upshot of installing the kiosks was that an increasing number of patients started paying overdue bills. Following a similar strategy in your organization can not only boost patient engagement but also make sure you collect patient payments without much of an effort.

5. Human resources amount for 56% of a provider organization’s operational costs.

Reduce cost-to-collect and improve net collections by empowering patients. Patient self-management can be the answer to some of the most puzzling questions care providers face. Encourage patients to enter data into their own records, educate them on patient portals and help them devise a plan to handle their healthcare costs.

A 2012 survey states that 79% of respondents would like healthcare organizations to conduct patient interactions online or through mobile phones.

Small steps in the right direction can help physician practices, to develop an architecture that increases patient engagement and improves the efficiency of their revenue cycle.

What to Look For When Evaluating a Medical Billing Vendor for Your Practice

If you’ve been practicing medicine for any amount of time you will probably agree that the healthcare industry has become incredibly complex in the past few years. Thanks to ever-evolving regulations and shifting reimbursement models, physicians are forced to streamline their operational processes in an effort to cut expenses and increase revenue.

One of the best ways practices can increase their revenue and stay competitive in a sometimes-shaky marketplace is to outsource their billing to a third-party vendor. But how do physicians ensure they select the right partner?

First by asking themselves a series of questions, and then asking their prospective partners another series of questions.

Questions to Ask Yourself

What are My Particular Pain Points?

Any billing company worth their salt will have policies and procedures in place that will maximize the efficiencies of your practice’s work flow and minimize the time it takes you to get paid. And, at this point in time, all quality vendors will have rigorous compliance programs that will ensure security, privacy and confidentiality of protected patient data.

But beyond these generalities that any physician requires, what are your particular challenges or issues you face on a daily basis? What are your personal pain points? What are your preferences – cloud-based or enterprise-wide solutions?

Once you have a list of your preferences and challenges, you will be more easily able to communicate them to potential partners.

What Stipulations Do I Require in the Contract?

A partnership is a two-way street and an effective contract will outline the vendor’s scope of work clearly as well as your responsibilities (i.e. provide all necessary documentation and authorization for services). Since using a generic contract template is asking for trouble, get some legal advice and determine your requirements: effective dates, termination clauses, compliance requirements, service reimbursement parameters and scope of work.

In What Ways Can My Billing Partner Help me Grow my Practice?

The right billing partner should not only be able to handle your payments and claims, they should also be able to counsel you and evaluate the health of your practice. Ask yourself what kind of assistance you need to determine if your current admin policies, staffing levels, and IT resources are sustainable. How can your billing partner help you make the necessary preparations to meet future goals?

Questions to Ask Prospective Partners

What Technological Capabilities Do You Offer?

Good billing companies offer more than help with claims and reimbursements, they have a breadth of knowledge when it comes to the best technology available to meet your needs and regulatory requirements.

Ask vendors what their experience is with EHRs, practice management systems, and if their solution can integrate into your existing systems. Remember, technology is multifaceted and should help you meet the clinical, administrative AND financial needs of your practice.

Is the Billing Company ICD-10 Ready?

At this point in the game, all billing companies should be up-to-speed with ICD-10, there simply is no excuse to be unprepared. Ask your prospective partners if they have completed end-to-end testing and have performed the appropriate training for their coders. Are they ready, willing and able to handle any reimbursement issues because of denied claims?

Do Any of Their Other Clients Share Your Specialty?

Let’s face it, coding and billing is complicated and there are different sets of rules depending on the specialty. Does your potential partner have experience billing for your specialty? If not, find one who does and can customize your solutions.

Whose Software Will You Use?

Will you continue to use your own practice management software (PMS) or does your vendor have their own? Most EMR software has practice management components built right in. If the vendor is going to be working on your current system, inquire who will cover the cost of the clearing house and if there are any fees that you will be picking up. If you will be using the vendor’s PMS, be sure to establish guidelines in the contract that states you have the rights to your billing data and reports.

Will They Perform Periodic Audits?

One of the biggest threats to a practice’s cash flow is complacency. For this reason it’s important your vendor performs periodic claims audits to catch any under- or over-coding. Ask them how often they do this (should be quarterly) and how many charts they cover (should be no less than 10).

How Many Certified Coders do They Have on Staff?

Inquire how many certified coders they currently have on staff and how many will be dedicated to your account. It is your right and responsibility to know exactly who will be working your claims and what level of training they have received.

How Often Will They Submit Your Claims?

It stands to reason that the frequency of claims submitted will determine your revenue flow. Claims can either be submitted daily, weekly or biweekly. Be sure to set the guidelines for how claims should be submitted to keep your cash flowing.

How Do They Handle Rejection?

While most human beings handle rejection of any kind rather poorly, it is the responsibility of your billing vendor to be great at handling rejections – claims rejections. Your vendor must be able to identify triggers and patterns of denials and fix the issues immediately for revenue growth.

Who Handles Patient Questions and Concerns?

Not all vendors field calls from your patients when they have questions about their deductibles and co-pays, so know ahead of time what your preference is. If you don’t want to have these calls routed to your practice then ask up front if this is something they handle.

What Kinds of Reports Do They Provide?

You should, without question, receive monthly financial reports from your vendor that include payments, adjustments, billable services, and accounts receivable. Also, find out if they can provide you with customizable reports, which can give you targeted data about denied claims and procedural codes.

Common Medical Billing Errors Which Affect Your Revenue

Almost 30% revenue loss results from billing errors. These errors are the common cause for claim rejections by insurance companies, aka payers in the US. Medical billing is much beyond just documentation; it is the very means of revenue generation. Since the maximum percentage of a physician’s income is from the payers, the billing process should be devoid of the following common errors.

1. Incomplete Patient Information

When it comes to detecting the loopholes in a business, it is best to start with the basics. It is necessary to check for silly mistakes while entering the name, date of birth, gender of the patient in the claims as errors detected by the payers will result in rejection.

2. Lack of Patient Verification

Lack of thorough patient verification process reveals potential chances for revenue loss. A complete verification should include verifying how many policies the patient has, the insurance policy number and its coverage, the allowance limit of benefits, checking for authorization of procedures, etc.

3. Date of Service and Timely Filing

It is true that a thing as simple as mentioning the correct date of service is important is often missed and becomes the cause of denial of reimbursement. Not only that, the claims need to be filed within a specific period from the date of service if physicians want the payment. Missing that deadline results in delay in getting reimbursed and often loss of revenue.

4. Erroneous Diagnosis/Procedure Code

The payers have experts on their panel to verify the authenticity of claims and cross check the CPT or HCPCS, i.e. diagnosis codes with the treatment rendered. In an attempt to get more out of the payers the billing staff often codes unauthorized procedures along with wrong diagnosis. One should be careful while using the modifiers too.

5. Duplicity/Fraudulent Billing

One of the most common malpractices for trying to get maximum reimbursement is fraudulent billing, i.e. billing for unperformed procedures. At times upcoding too falls into this category. The billing staff should be well versed with the latest coding standards to avoid coding the old way. Downcoding too is tricky and can harm revenue.

6. Following up with Payers

Lack of following up with the insurance companies for rejections tops the list of the most common medical billing errors that cause monetary loss for medical practices. Blame it on staff shortage, increased workload, predominant administrative tasks over billing, lack of time for being on call for every rejected claim, following up can help the inflow of cash.

7. Ignoring the EOB

It is crucial to go through and understand the explanation of benefits (EOB) issued by the insurers. Apart from making the rectification, it is also essential for avoiding those mistakes in future billing.

All these errors delay the reimbursement unnecessarily besides risking tarnishing of your practice’s image in case of repetitive errors. Seek help from a billing partner if need be to handle these issues and avoid these pitfalls to keep the cash coming in.