In a memorandum released on June 25, CMS announced the end of the COVID-19 emergency waiver for staffing data submissions.
Back in March, CMS had granted a series of blanket waivers to lessen administrative burden and allow nursing homes to focus on responding to the COVID-19 threat. Facilities now must resume submission of their staffing data through the payroll-based journal (PBJ) system as required by regulation.
Why it matters
A recent study published in the Journal of the American Geriatrics Society found that facilities with lower nurse staffing levels and lower scores on the Five-Star Quality Rating System before the pandemic had higher rates of COVID-19 infections and deaths. In fact, higher nurse staffing ratios were strongly correlated with fewer cases and deaths.
The authors of the study recommended that nursing home inspections should target facilities with lower RN staffing levels and quality ratings in addition to those located in areas with high infection rates.
On the heels of these findings, CMS made the announcement that nursing homes must recommence submission of their staffing data, stating that “we continue to emphasize the importance of staffing based on its relationship to quality.”
What this means for your facility
Here’s what you need to know about PBJ data submissions for 2020:
- Staffing data for April-June is due by the usual deadline of August 14
- You are not required to submit your staffing data for January-March
- Nursing Home Compare is displaying the staffing star rating based on your October-December 2019 data
- New Five-Star staffing ratings, based on your April-June data, will post at the end of October 2020
- Facilities that received an automatic staffing downgrade to one star for the fourth quarter of 2019 will have their measures and rating temporarily suppressed and that one-star staffing rating downgrade removed
How ABILITY can help
While CMS is giving long-term care providers the opportunity to correct and improve their star rating, the agency plans to restart inspections “as soon as possible.” To protect your star ratings and ensure compliance with the PBJ reporting requirements, it is crucial to act soon. This is where ABILITY can help.
ABILITY CAREWATCH PBJ puts the right tools at your fingertips so you can efficiently collect, classify, validate and submit your facility’s direct care staffing data accurately and on-time.
To see firsthand how easy PBJ reporting can be, request a demo today.
ABILITY and design®, ABILITY® and CAREWATCH® are trademarks of ABILITY Network, Inc.
Uncompensated care is a growing concern for hospitals, health clinics and skilled nursing facilities.
In 2016 and 2017, community hospitals provided $38.4 billion in uncompensated care—a $2.3 billion increase from 2015.1 Between 2012 and 2017, bad debt resulting from Medicare patients not paying deductibles and coinsurance increased by 17%.
How can healthcare organizations actively combat write-offs and payment delays while maintaining high patient satisfaction? One way to do so is through proactive financial clearance.
What is financial clearance?
Financial clearance is a process that determines a patient’s ability and likelihood to pay. Using that information, providers can design intake and collection processes tailored to the unique needs of different patient populations, including eligibility for financial programs, patient counseling and payment plans.
In short, financial clearance improves the patient experience and the productivity of your staff.
A rising need for payment flexibility
With high-deductible health plans on the rise, more patients are opting to self-pay for medical care—but it’s an uphill battle for the average American. Forty-four percent of adults don’t have the savings to cover an emergency expense of $400 or more,2 yet the average outpatient hospital visit costs almost $500.3
For those who do use insurance to cover medical expenses, the costs are also going up. The average patient balance after insurance (PBAI) rose from 8% of the total bill in 2012 to 12.2% of the total bill in 2017.4 The average family spent $7,726 on premiums and cost-sharing in 2018, an 18% increase over the $6,571 spent in 2013.5
The growing financial burden on patients makes it tougher for healthcare organizations to collect. Not only that, but it can lead to feelings of frustration and confusion, which hinder the patient experience.
Tackling financial conversations head-on with proactive financial clearance gives providers a clearly defined path toward the most likely payment method while helping patients feel confident about the options they have to pay for care.
How does financial clearance work?
Financial clearance combines two complementary components: patient identity verification and propensity-to-pay scoring.
Credit and non-credit data sources are used to verify identity and address data during admission or intake, which cuts down on patient information errors. Incorrect patient information is one of the leading reasons for claims denials and past due accounts, which cost time and slow down the revenue cycle.
Next, the patient (or financial guarantor) is assessed a propensity-to-pay score, which indicates the individual’s ability and likelihood to pay. The score is linked to a set of custom messages designed to help segment patients into various population groups. For example, a score within one range might prompt the user to collect a co-pay on the spot, while a score within a different range might recommend an installment plan.
In this way, healthcare organizations can capture payment more confidently knowing they’ve offered the most suitable option for the individual. In turn, staff spends less time acting as a bill collector and patients leave with a sense of empowerment over the cost of their care.
Boost payments with ABILITY COMPLETE Financial Clearance
Whether you’re a hospital, ambulatory care center or skilled nursing facility, ABILITY can help you analyze where and when you’re most likely to collect. Strengthen your financial performance, improve your staff’s productivity and most importantly, better serve your patients. Request a complimentary demo of ABILITY COMPLETE Financial Clearance today.
1 “American Hospital Association Uncompensated Hospital Care Cost Fact Sheet,” January 2019, https://www.aha.org/system/files/2019-01/uncompensated-care-fact-sheet-jan-2019.pdf
2 “Federal Reserve Report on the Economic Well-Being of U.S. Households in 2017,” May 2018, https://www.federalreserve.gov/publications/files/2017-report-economic-well-being-us-households-201805.pdf
3 “Study: Average hospital outpatient visit cost approaching $500,” Tauren Dyson, United Press International, December 13, 2018, https://www.upi.com/Health_News/2018/12/13/Study-Average-hospital-outpatient-visit-cost-approaching-500/6121544734917/
4 “Patient Balances After Insurance Continue to Increase in 2018, Driving Bad Debt and Uncompensated Care,” TransUnion, June 26, 2018, https://www.globenewswire.com/news-release/2018/06/26/1529420/0/en/Patient-Balances-After-Insurance-Continue-to-Increase-in-2018-Driving-Bad-Debt-and-Uncompensated-Care.html
5 “Tracking the rise in premium contributions and cost-sharing for families with large employer coverage,” Matthew Rae, Rebecca Copeland and Cynthia Clark, HealthSystemTracker.org, August 14, 2019, https://www.healthsystemtracker.org/brief/tracking-the-rise-in-premium-contributions-and-cost-sharing-for-families-with-large-employer-coverage/
ABILITY and design®, ABILITY® and ABILITY COMPLETE® are trademarks of ABILITY Network, Inc.
While healthcare profit margins continue to dwindle, the aging population increases. According to the U.S. Census Bureau, by 2030, adults aged 65 and older will outnumber children under the age of 18 for the first time in history!1 That makes it imperative that home health, hospitals, physicians’ offices, and other healthcare organizations find ways to do more with less. Finding home health billing solutions that streamline the scheduling of physicians and nurses and shortening the turnaround time for Medicare payments is crucial. Learn how home health billing works to navigate the best practices for success.
Step 1: Getting approval for patient services
The first step in home health billing is to connect with the patient and the physician to identify the services needed. The next step is to determine financial responsibility for that care (e.g., any combination of Medicare/Medicaid, supplemental insurance and private pay). Medicare will generally only pay for home health services that involve nursing care, physical therapy, occupational therapy or speech therapy. Home or personal care assistance are generally not covered by Medicare or supplemental insurance plans. Patients also must be homebound and meet a variety of other requirements for 100% reimbursement. With an all-payer eligibility management system, you can manage multiple payers, tasks and activities as well as assign and prioritize patients to keep the billing process moving smoothly.
Step 2: Checking Medicare/Medicaid eligibility
Once you determine the services and timing required, and have assigned the correct billing codes, the next step is checking the patient’s eligibility with Medicare/Medicaid. Having access to Medicare’s HETS database will make checking eligibility much easier as it gives your staff real-time, detailed eligibility and benefits information at the onset of a patient’s stay.
Step 3: Submitting the claims
Once care is provided, you will need to submit the claims to Medicare/Medicaid and to any supplemental insurance companies for payment. With all of the potential for human error in the billing process, automating your Medicare claims submissions can save you time and money. This efficiency can improve your cash flow and maximize your revenue. Automation helps eliminate ongoing follow-ups, reduces multiple contacts with payers and helps ensure the claims are processed without errors.
Step 4: Resolve denials
Because you are working with a variety of physician services, coding numbers, payers, and rules and regulations, there are bound to be times when claims are denied by either Medicare/Medicaid or private insurance. With powerful software solutions like ABILITY EASE All-Payer, you can automate the claims denial process and the correction of complex, multi-step claims. From a single dashboard, you can track appeals and communicate securely to resolve denials and improve cash flow. Automation can also free up your physicians and nurses so they can focus on seeing and treating more patients.
Step 5: Collect balance due from patient
An often overlooked, but important process in home health billing is to collect the balance due through patient payments. It’s important for patients to understand the bill, the itemized charges and the portion of the bill that was paid by insurance. Since only 50% of patients who experience billing difficulties pay their bill in full,2 it’s imperative to make patient payments as easy and convenient as possible.
Simplify your home health billing with ABILITY Network
Home health agencies have plenty to manage without having to worry about billing processes that can easily be upgraded from manual tasks to automated workflows. Whether it’s physician or nurse scheduling or researching denied claims, the powerful automated technology offered by ABILITY can help you. Give us a call today at 888.895.2649 and find out which software systems will work best for your needs. Or, request a no-obligation quote online. We’ll show you how we can increase your revenue cycle management and increase your cash flow!
1 “Older People Projected to Outnumber Children for First Time in U.S. History,” U.S. Census Bureau, March 13, 2018, https://www.census.gov/newsroom/press-releases/2018/cb18-41-population-projections.html
2 “How Patient Experience in Billing Offices Impacts Patient Payments,” Sara Heath, Xtelligent Healthcare Media, October 15, 2018, https://patientengagementhit.com/news/how-patient-experience-in-billing-offices-impacts-patient-payments
ABILITY and design®, ABILITY® and ABILITY EASE® are trademarks of ABILITY Network, Inc.
Regardless of the business you’re in, the capability to efficiently capture, manage and collect revenue is critical to success. Many healthcare organizations are turning to revenue cycle management (RCM) vendors and their high-tech software applications to help them achieve consistent profits. The demand from home health, physician offices and hospitals has resulted in a consistent stream of new RCM companies providing these services. But how do you decide on the RCM platform that’s right for your healthcare operation? Here are the top five things to look for in a revenue cycle management provider.
1. Comprehensive, customizable applications
One of the first things you should look for in a revenue cycle management provider is a full range of RCM components. Depending on your organization’s size, your current staffing and your top priorities, you may need a customized application that is just right for you. A company that offers an “all-or-nothing” approach won’t have the flexibility to meet your specific needs. In addition to all-payer claims and remittance processes, you may need physician scheduling or Medicare eligibility verification at some point. Ideally, you want to choose an RCM vendor who can help you identify your needs and then be equally happy to partner, to consult, to co-manage or to fully outsource their revenue cycle management. Plus, if you start small, you want a provider who can easily add-on the services you need as you grow.
2. Technology and security
Rapid technology changes are common in healthcare. You’ll want to make sure you hire a revenue cycle management provider who offers the most productive and efficient technology, including cloud-based software that’s reliable, easy to use and connects to your existing software. You’ll also want a vendor who stays ahead of changes in technology, modifying their products to bring the best to their customers.
3. Trust and transparency
Your revenue cycle management provider will be critical to your organization’s overall success. That’s why both trust and transparency are so important. Do your homework and read reviews, look at customer testimonials and business case studies. Investigate the company — how long have they been operating? Who are their owners? How involved are they in the industry? What is their financial health?
With regard to revenue cycle management software, will you have full access to manage claims and pull reports? You should have transparency when it comes to knowing and understanding the work that is being performed.
4. Effective software processes
When choosing a revenue cycle management provider, you want to make sure the automated processes implemented by the software are effective and easily customizable to your specific needs. That means your RCM platform needs to support rapid turnaround time for claims, as well as a low percentage of denied claims and a process for resubmitting those claims. Find out what the provider’s denial management strategy is — what percentage of claims are denied in the first place and how many will be resubmitted? You want your RCM vendor to take an active approach to quickly submitting claims and have the processes in place to appeal denials.
5. Personalized customer service — training and reporting
Get to know your potential providers and know the person who will be directly responsible for ensuring the success of your revenue cycle management program. Will that person run, analyze and review reports with you on a regular basis? Are they or other customer service personnel available 24/7? What is their level of expertise in working with healthcare systems like yours?
Part of great customer service includes proper onboarding of the new system with current employees. Make sure your RCM vendor provides onsite training to help you transition to their services.
Discover the difference at ABILITY Network
When searching for the best revenue cycle management provider for your physician practice, hospital or health system, consider ABILITY Network. You’ll find we score at the top of every important criterion you need for a high-quality RCM process. We understand your goal is to maximize revenue and we have the processes and technology to help you do just that. Streamline your workflows, avoiding coding errors and reducing denials means you get paid faster. And when you expedite your cash flow, you’ll have more money in the bank. Improving efficiencies enables your organization to do what you do best — take care of patients. Call 888.895.2649 and let us throw our hat in the ring as your revenue cycle management software provider!
ABILITY and design® and ABILITY® are trademarks of ABILITY Network, Inc.
Revenue cycle management (RCM) in healthcare is the fiscal process that guides the identification, management and collection of payments for patient services. The process begins with patient pre-registration, is followed by claims submission, and concludes with remittance processing. We understand hospitals, physician practices and other healthcare operations want to prioritize their limited funds to improve facilities for patients and retain caring, skilled staff. Revenue cycle management in healthcare can help you do just that by streamlining and automating the process of receiving timely payments. The objective of RCM is to generate a system that helps you get paid the full amount for the care provided as quickly as possible. Successful implementation of your revenue cycle management is what pays the bills. Learn more about the healthcare revenue cycle and the seven basic steps your RCM process should focus on.
Step 1: Patient pre-registration
Your revenue cycle management process starts when the patient makes his or her appointment. To successfully collect patient payments, healthcare organizations must engage the patient throughout the process. The best way to start is during the first contact with your patient. You’ll establish the patient’s account and collect as much information as possible during this step, including payer information (insurance or other payers such as Medicare/Medicaid), and the medical history you’ll need later in the cycle. Next, you’ll distribute information to the appropriate doctors, nurses and administrative personnel to enable the best possible care.
Step 2: Pre-authorization
In the next step, staff will schedule visits and verify insurance eligibility. Confirming that the service is medically necessary according to the plan’s agreement (assuming it is not a medical emergency) will confirm benefits and help determine payment options. This process can be trying and time-consuming for healthcare staff. Often, organizations employ software that assists in checking patient eligibility electronically, which can expedite the process.
Step 3: Submitting claims
A claim is used by healthcare providers to submit and receive funds from insurance companies or other payers. A “clean claim” that gets reviewed and paid by a payer upon initial receipt expedites reimbursement and improves your cash flow. It’s very important that the physician records information accurately. Without accurately documenting the clinical service provided and attaching the correct code(s), the claim could be denied, or you could receive an incorrect reimbursement. Good software can submit claims electronically, helping to avoid human error. It’s best if a charge capture system can interface with the electronic medical record (EMR) to optimize identification and capture of charges for more complete billing. You may also want to consider centralized charge standards across all departments to improve consistency. ABILITY Network has several RCM applications to help you streamline your claims management and billing and ensure compliance with CMS guidelines.
Step 4: Posting of the payment
Once you receive the insurance payment and it is posted to the account, you can submit the balance to the patient for payment. Once you have developed a relationship with the patient and gathered contact information, you should be able to use automation tools to send billing statements via mail and/or secure electronic data interchanges (EDI). You could also implement text message reminders. The easier you make it for patients to pay during this step, the faster you will receive payment.
Step 5: Managing and re-submitting denied claims
Tracking your denied claims is an important part of revenue cycle management in healthcare. Claims can be denied for various reasons, such as improper coding, missing items in the patient chart or incomplete patient accounts. Having a process to manage denials can help you recover revenue that might otherwise have remained overlooked because of insurance being filed incorrectly. Properly executed denial management will boost earnings if cash flow has been slow because of problematic claims. You might uncover denial patterns or trends, whether from human error or billing problems for certain types of procedures or members of your patient population. For anything that is not covered by insurance, healthcare organizations must notify and collect payments from the patient. It’s essential that providers help patients understand what they owe and why, identify primary or secondary insurance, consolidate bills, and be able to set up payment plans.
Step 6: Processing payments
Accounts receivable staff should verify all claims payments and process them as quickly as possible. The goal should always be to collect the maximum revenue in the shortest amount of time. You may need account specialists to help identify problem claims and to work with patients on collecting balances due.
Step 7: Financial reports
No automated RCM process is complete without the capability and processes needed to prepare valuable financial reports. Using custom software to develop the financial and management reports you need is key, along with reports on key performance indicators (KPIs) to track whether or not your team is meeting their defined goals.
Let ABILITY simplify your healthcare revenue cycle management
No doubt many medical practices, hospitals and other healthcare providers want to focus more on treating patients than ensuring the financial viability of their company. However, your revenue cycle management process is crucial to running your organization successfully. Without this key financial process, providers cannot keep their doors open to treat patients. That’s where ABILITY can help. We put systems in place to streamline claims management and billing, increase the flow of income, improve the care of your patients and reduce provider costs. Find out how we can help by reaching out via phone at 888.858.0506 or requesting an online quote. We look forward to helping you simplify and optimize your RCM process.
With so much attention on data – from strategies and ownership to data centralization, integration, mining and ethics – it can be easy to overlook the power of simple data sets. Staffing decisions have significant financial implications, and because overtime is one of the more visible drains on healthcare budgets, it tends to get the most attention.
However, for most healthcare managers, preventing overtime is a massive challenge. If overtime data is sitting in a report somewhere, managers don’t have real-time access to that data when they need to make a quick decision.
Even if you are doing an outstanding job of collecting and maintaining staff data, it may not be enough to reduce overtime and the associated costs. Healthcare managers must have easy access to meaningful data – at the moment they are making staffing decisions.
Solving the overtime conundrum
Overtime occurs because of two reasons: the decision maker didn’t know the person would go into overtime or the decision maker knew about the overtime and made the decision anyway.
While setting policies on overtime use and approval processes can help reduce overtime, a better solution is to make readily available the tools and data necessary for informed staffing decisions.
Something as simple as displaying an alert that an employee is or will be in overtime prompts decision makers to look for other options. Assessing those options can be quicker and more efficient with an Avoidable Overtime function, like the one that is integrated into ABILITY SMARTFORCE Scheduler. The feature displays other qualified staff members who aren’t at risk of going into overtime, so the manager can make a quick, informed decision.
Consider the difference:
John is a manager in the ICU, and he is looking at the staffing for the next shift. He has had two admissions and the unit is busy. He has his hands full and the evening shift is short one RN.
- Scenario 1: John asks one of the nurses from the day shift to stay over. Expensive, but efficient.
- Scenario 2: John opens his iPad and instantly sees staffing for his unit showing that he is down an RN. With one tap, he gets a view of staffing in the other ICUs and sees that none of them have extra staff to offer. He taps back to his shift and receives a list of available nurses. Two of the three have an indicator letting him know that they would be in overtime if selected. He taps on the third and instantly sends a text offering her the shift.
In the second scenario, John had easy access to the data he needed to make a cost effective decision, including:
- Visibility into other units that are staffed with the same skill type he needed
- Who was available
- Who was in overtime
- Who last called off
Plus, he could contact a nurse to fill the open shift, all in a matter of seconds. That data enables John to manage overtime costs, while also allowing him to be fair and in compliance with the seniority policy. He also minimizes risk by avoiding having a fatigued nurse giving care.
With the availability and affordability of staffing applications on the market, you simply can’t justify staffing practices that are not supported by data. So, if you are still using paper-based scheduling, spreadsheets or outdated staffing technologies, contact us today to learn more about ABILITY SMARTFORCE Scheduler, a cloud-based application that streamlines staffing and provides you with instant access to the data you need to make the right decision fast.
To see it in action, request a demo now.
ABILITY and design®, ABILITY® and ABILITY SMARTFORCE® are trademarks of ABILITY Network, Inc.
A healthy relationship between staff members and their manager can positively impact turnover rates, vacancy rates, percentage of sick calls, quality of work and staff satisfaction scores.
With so much at stake, it is critical that healthcare leaders make it a priority to foster strong relationships with their employees. That can be daunting for busy leaders who already feel like they don’t have enough time to cover their duties and focus on quality of care.
However, improving your relationship with your staff might be simpler than you think. In fact, here are ways that a scheduling application can support healthy staff-manager relationships.
Encouraging respectful communication
Eliminating all those phone calls asking staff to work saves time and honors employees’ personal lives. With the right scheduling application, you can notify staff of an open shift with a single tap, and they can just as easily respond if they are available to work.
Staying connected on the go
You no longer need to be at home or near a computer to know what’s going on. With healthcare scheduling applications, you and employees can see up-to-date schedules, receive notifications of open shifts, swap shifts or read announcements – on your mobile device from anywhere.
When you and your employees have full visibility into your staffing needs, employees are empowered to engage in the scheduling process. Staff members are more likely to fill open shifts when they can easily see what is needed and then volunteer without dealing with a bunch of red tape. That saves you so much time.
Enabling staff to swap shifts with other qualified staff allows them to self-manage life situations or changes that come up. They don’t have to explain their circumstances to their managers, who simply review and approve shift swap requests as they appear. That offers employees some control over their shifts, which can improve job satisfaction.
Enabling managers to focus on what’s important
Simplifying scheduling and getting staff more involved frees your time to support staff and build a positive culture. It also allows you to spend more time with patients and ensure an overall high quality of care.
It’s easier than you think to adopt cloud-based scheduling. In fact, many solutions don’t require any IT help, and all maintenance and upgrades are taken care of for you. Plus, all that can be bundled into simple monthly pricing that is very affordable and has no hidden costs or surprises.
If you are ready to support a healthier work environment, take advantage of next-generation scheduling solutions. Learn more now.
ABILITY and design® and ABILITY® are trademarks of ABILITY Network, Inc.
Data-driven or evidence-based decision-making is a must in today’s world of staffing and scheduling. We use data to inform decisions, track the impact of decisions, defend decisions, and identify ways to avoid repeating mistakes in the future.
The challenge for most of us has always been that the data required to make the right decisions is rarely easily accessible when we need it. When it comes to scheduling, it is not realistic to expect staff managers to make quick, accurate data-driven decisions when the data is buried in email, paper reports and filing cabinets.
The good news: technology can put that data at your fingertips
Scheduling applications are designed to expand visibility into key data right at that moment when decisions are made.
The following types of information can be available instantly:
- Overtime amounts
- Date last called off or on
- License expiration
- Missed clock-ins
Additionally, with just a tap, you can drill down into more detail. That level of visibility into the data you are already collecting during day-to-day activities enables leaders to make quicker, smarter decisions and improve consistency, fairness, quality and the bottom line.
The right data at the right place and time
These days, most people are inundated with data, and they don’t know how to apply it or use it to improve their decisions. When you evaluate scheduling applications, don’t just consider how much data you’ll receive. Instead, make sure you have the right data, displayed in the right places. It’s ideal to have all the data you need to reference on the same screen where you are actually making staffing decisions. It’s just a more efficient, productive, less error-prone way to work.
For example, when you’re making a choice between three qualified staff members, you will make the best decision if you can easily see relevant information right next to their names:
- How many hours they have already worked
- Who is in overtime
- Who called off last
- What their seniority is
- What their pay rate is
- Their skills and credentials
Well-designed and modern staff scheduling software offers that functionality, empowering you to make quicker, smarter decisions.
ABILITY SMARTFORCE Scheduler is a cloud-based application that streamlines staffing and enables you to manage and update your schedule from your phone.
To see it in action, request a demo of ABILITY SMARTFORCE Scheduler now.
ABILITY and design®, ABILITY® and ABILITY SMARTFORCE® are trademarks of ABILITY Network, Inc.
We understand that your focus is (and should be) caring for your patients. But we also understand that patient care cannot happen without processes in place to ensure proper payment of expenses. With ever-changing healthcare regulations and new reimbursement models, it’s imperative for healthcare organizations to maintain a strong, stable revenue cycle management (RCM) process.
ABILITY Network has developed a variety of applications to help your staff save time and simplify complex tasks. Here are our seven best practices to help you develop and implement a successful RCM program.
1. Collect more information up front
Because the patient is such an increasingly important payer in today’s healthcare system, it’s crucial to collect all personal information available at the time a patient first seeks care — potentially even before they arrive for an appointment. Not only does this information provide the foundation for the claims you will process, but it will also dictate how you will collect payments from the patient or make payment arrangements for the balance due. Effective communication helps patients to understand their benefits and possible treatment alternatives.
2. Aggregate the data
As benefits and insurance regulations continue to change, it’s important to implement a revenue cycle management process that is able to aggregate all of the data throughout the cycle. It will provide benchmarks and analytics for key insights that can improve your process and your business success. Sometimes there is little you can do to increase your income and you may need to look at the expense side of the business. Easy-to-read financial reports can help management and staff to better understand expenses, ways to reduce costs and maximize revenue where possible.
3. Consolidate revenue cycle management to a single provider
Some healthcare organizations use multiple vendors for different revenue cycle functions, requiring extra time and resources to manage it all. Instead, consider consolidating your revenue cycle management operations to a single provider who can provide eligibility verification, claims management and patient payment processing. A single, comprehensive system streamlines workflows, increases staff efficiency and simplifies the billing process for patients, which can help them better understand and meet their obligations.
4. Collect patient payments at or before the point of service
This is one of the most difficult parts of revenue cycle management, but also one of the most critical. Collecting patient payments — as much as you can, as soon as you can — is important in keeping your organization’s money flowing. Determining Medicaid and Medicare eligibility and helping patients understand their coverage options is key. This is made easier by developing a relationship with patients and educating them on the insurance process, so they understand their financial responsibility ahead of time. As medical deductibles increase, more patients are having to pay more and may need to arrange financing or payment options prior to receiving non-emergency services.
5. Track claims throughout their lifecycle
Identifying the reasons for claims denials is as important as resolving them. Verifying insurance eligibility is the first step to ensure accurate billing. It’s also important to be able to track claims from submission to payment. Claims denials from Medicare and other payers should be recorded and analyzed to look for trends or common errors that can be corrected to stop the cycle of lost revenue.
6. Implement staff development programs
One of the best ways to reduce denied claims is to ensure they are coded and processed correctly. As healthcare changes so quickly, it’s important for providers to develop and implement regular education programs for employees that teach proper coding techniques, comprehensive chart documentation and financial policy reminders. Besides reducing medical errors, training can also help reduce employee turnover.
7. Keep improving performance
Even if your revenue cycle is functioning nicely, avoid the maintenance-mode mentality. Instead, keep pushing for optimum performance that maximizes your cash flow and net revenue. Use your data to find ways to earn a little more and to save a little more – perhaps by cutting costs, decreasing denials and reducing bad debt and underpayments.
Contact your revenue cycle management experts today
When you need assistance implementing best practices for your revenue cycle management process, reach out to the experts at ABILITY. We have powerful applications to develop and maintain positive revenue cycles within your physician practice, hospital or other healthcare organization — no matter the size. Request your free quote today and start maximizing your revenue.
For physician practices, hospitals and all healthcare organizations, streamlining your revenue cycle management is critical. One of the best ways to recoup payments faster is with up-front Medicare eligibility checks. With the changes in the Affordable Care Act, patient responsibility is often in play and healthcare organizations who can communicate effectively with patients about how to pay for their medical treatment will be more successful at collecting full payments. At ABILITY Network, we offer a quick and easy way to check Medicare status online.
Why checking Medicare status is important
Medical benefits are always changing so it’s important to check the Medicare status of your patients often — whether it’s for prescription drugs or a specific procedure. This can cause a strain on some physician practices, care facilities, hospitals and other healthcare organizations. Save staff time and resources and quickly determine Medicare status with ABILITY CHOICE Medicare Eligibility. With 24/7 access to Medicare’s HETS database, your staff will be able to gather real-time, detailed eligibility status and medical benefit information, allowing you to:
- Receive payments faster by verifying Medicare eligibility at the beginning of patient care
- Reduce staff workload
- Quickly identify Medicare replacement plans and secondary payers
- Reduce denied claims with upfront identification of Medicare supplement or Medicare Advantage plans
How often should you check Medicare eligibility?
It’s important to check your patient’s Medicare eligibility throughout their course of treatment. Working with an information technology company like ABILITY can help reduce the time spent completing these frequent Medicare status checks. At the very minimum, you should check Medicare status:
- The first time the patient reaches out to you for medical service
- Before any submission of a home health request for anticipated payment (RAP)
- Before any submission of a hospice notice of election (NOE)
- Before every claim submission
What information do you need to check Medicare status?
To check Medicare eligibility, you must have the following patient information:
- First and last name
- Medicare Beneficiary Identification number (MBI)
- Date of birth (month, day, 4-digit year)
What can you communicate to patients with a Medicare eligibility check?
Communicating often and effectively with patients is key to receiving complete payment for medical services in a timely manner. Being able to check Medicare status quickly and often will allow you to know and communicate to patients:
- The deductible amount they have remaining for the year
- Information about their primary insurance if Medicare is the secondary payer
- Any patient-enrolled Managed Care Organization (MCO) or Health Maintenance Organization (HMO)
- That status checking is 100% HIPAA compliant
Let ABILITY help with your Medicare eligibility checks
No matter the size your practice or healthcare organization, ABILITY can help simplify complex revenue cycle management processes with the latest data-driven applications. You can count on us to optimize reimbursements and the quality of care you offer. Request a demo of ABILITY CHOICE Medicare Eligibility today. We look forward to helping your organization grow!