When you think of patient satisfaction, patient payments is probably not the first thing that comes to mind. But, if you take a deeper look into your patient payment processes, you’ll find a lot of avoidable inefficiencies. These can lead to hassles and inconveniences for your patients. Getting rid of them could be the key to a better overall patient experience.
You already know that accepting patient payments can be cumbersome. Billing staff members spend a lot of time every day on fragmented, manual processes that could easily be centralized and automated.
Let’s dive into a few of the things in your patient payment processes that frustrate your patients and waste staff time — and discuss how to fix them.
Centralize payment processes
Many organizations still use a collection of payment paths and processes. Your patients may pay you with cards, cash and checks at point of service, but they also mail checks to your office that have to be batched or scanned and deposited. If you have an online payment option, it may only accept cards and route payments through another vendor with an entirely separate process.
All those payment avenues should make patient payments more convenient, but they often have the opposite effect. They’re fragmented and confusing, and they leave your staff and your patients in difficult situations.
If you can centralize all your patient payment avenues, you can save time for your staff and give your patients more payment options.
Automate bookkeeping processes
Of course, accepting payments is only the beginning. After you accept patient payments, you have to log everything and ensure that your books are in order.
Daily balancing is a cumbersome and painstaking task. In reconciliation, your front desk staff have to pull data from banks and card processor reports, track cash taken in each day and ensure that all transactions balance correctly.
And what happens when a patient needs a receipt or refund from previous services? With different processes, finding and fulfilling this request can take precious time. Patients feel neglected, and staff are left with unnecessary added work.
If you switch to a single source for payment processing, you can eliminate these inefficiencies and free your front desk staff to focus on your patients.
Offer automated payment plans
How do you handle patient payment plans? Does the burden of monitoring payments fall on your staff? When payment plans aren’t automated, your front desk and billing staff are tasked with keeping track of every patient’s payment schedules, notifying patients when payments are due and following up after payments are made or if payments are late.
Organizations spend a lot of time sending statements and following up on outstanding balances, but that’s not necessary when you automate the process. Payments can be processed automatically each month, and you can greatly accelerate A/R while cutting down on collections. Once claims are adjudicated and accounts receivable are determined, you can charge the correct balance without a lot of extra work.
ABILITY® helps all organizations, from billing agencies to healthcare providers, streamline their patient payment processes every day. With a single platform — ABILITY SECUREPAY® — you can collect more revenue faster while enhancing patient convenience with card-on-file services and automated payment plans. At the same time, you can boost patient satisfaction by offering more payment options for your patients, including online options and check payments.
For more information on how you can streamline your patient payment process and capture 100% of your patient payments in a single platform, read about ABILITY SECUREPAY here.
Healthcare organizations have various metrics that help define and measure success. With so many moving parts, how do you determine what to prioritize?
A strong and efficient revenue cycle is the cornerstone of your organization, so it’s important to start there. It is responsible for paying salaries, buying new equipment and even keeping the lights on.
Are you making the most of your revenue opportunities? Below are three common mistakes that compromise cash flow, and what you can do now to correct them.
Failing to verify eligibility before providing care
Ideally, providers would prefer to verify eligibility for every patient before they receive care. In the real world, this isn’t always possible. Many things can prevent prior authorizations, ranging from unforeseen emergencies to a busy day in the front office that simply doesn’t allow the time.
While you can’t eliminate emergencies, there are ways to cut down on the mountains of paperwork facing your office staff. How many administrative tasks are performed manually? And of those that are electronic, how many different screens do they have to log into to confirm eligibility for just one patient?
Electronic claims management saves a substantial amount of time by enabling batch inquiries and alerts to indicate additional coverage for Medicare beneficiaries. You can verify eligibility for more patients in less time without rejected claims headaches after the fact.
Operating with a fragmented claims management workflow
Speaking of claims, is there anything that requires more time and attention than managing multiple claims with multiple payers? From unique business rules to confusing rejection codes, claims management is usually fraught with long A/R cycles and time lost trying to locate and manage missing claims.
Make your claims submission process more efficient from start to finish with ABILITY EASE® All Payer. With a single platform, you can manage CMS and all other commercial payer claims, verify claims against the most current business rules (as well as customize unique rules for specific payers), and even address eligibility issues up front, prior to claim submission. Most importantly, you can achieve acceptance rates of up to 98 percent.
When rejections do happen, the claim immediately returns to your work queue with a clear message about the correction needed. No more trying to decipher confusing codes while your A/R days pile up.
Writing off denied, low-value claims
In the hustle and bustle of a busy workday, it’s not surprising that low-value, rejected claims become the lowest priority. Billers are stretched thin and their time is better spent working on new, possibly higher-value, claims. But it shouldn’t come down to one or the other. Using the right technology, your staff can successfully handle all types and give a needed boost to a sluggish revenue cycle.
If you don’t find time to settle all of your claims, you aren’t collecting all the revenue you’ve earned. These “low-value” claims add up over time, so what seems like a reasonable write off could result in the loss of thousands of dollars. Not taking the time to resubmit these claims also contributes to poor A/R performance and patient frustration.
Some simple steps you can take to address this issue include:
- Have staff verify coverage and eligibility prior to treatment
- Use historical patient data to create new claims
- Track claims from submittal through payment
The single best thing you can do to strengthen your revenue cycle is to prevent as many rejected claims as possible. This is where electronic claims management systems can have a huge impact.
What do predictive analytics and insights have to do with getting more hospital referrals?
When you brainstorm ways to gain more referral sources, what comes to mind first? You may think of sending your business development team out on more calls, or even hiring more representatives to reach a wider range of hospitals. But putting more feet on the ground is expensive — and it isn’t the only way to increase your market share.
In fact, if you leverage the latest technology, you can do a lot more to get those referrals — without hiring more staff and increasing your overhead. Let’s take a look at some of the ways you can boost your competitive edge with analytics.
Discover untapped referral opportunities
Have you been reaching out to the right hospitals for referrals? Traditional business development strategies lack the insight to see which hospitals need to refer patients to facilities with your strengths. Find out more about patient movement by referral source or destination, and monitor your organization’s performance along the way.
Use analytics to identify your competition
Should you be worried about the facility across the street? Let’s say, for example, that you know of a few post-acute care providers in your area. You know that they serve patients with many of the same conditions that you do, and you know that your target referral sources overlap with theirs. To stand out, you need to know how your care compares with theirs.
With the right tools and the right data, you can see where your quality of care surpasses other post-acute care facilities, where you have room for improvement and where you have a competitive edge. You can then make strategic decisions about which hospitals you should be targeting and how to approach them for referrals.
Analytics can help identify market trends
For years, analytics tools have provided access to past market trends. However, legacy analytics tools could only look back. Their data inevitably lagged and couldn’t accurately project what was to come.
Next-generation analytics tools give you an up-to-the-minute view of market trends with accurate projections. You can use this data to make effective improvements to your quality care, target the right hospitals at the right times and improve your messaging to stand out as the top choice for referrals.
With the analytics in ABILITY INSIGHTTM Referral Mapper, you have the power to improve your business development strategy and significantly increase your market share.
The Patient-Driven Payment Model (PDPM) that goes into effect on October 1 is the largest financial change the industry has seen in 20 years.
The Centers for Medicare and Medicaid Services (CMS) changed the fee-for-service reimbursement model to a fee-for-performance model, also known as value-based care.
CMS’ objective with PDPM is to remove the financial incentive to provide routine therapy to patients regardless of their unique characteristics, goals or needs. Instead, PDPM classifies patients into payment groups based on specific, data-driven patient characteristics.
When the new structure goes into effect later this year, all skilled nursing facilities will be expected to comply immediately. How you fare during the transition depends on how well you plan ahead. Read on for four smart ways to prepare for PDPM.
Prioritize staff training
The implementation of PDPM will make it more important than ever to complete accurate and detailed Minimum Data Set (MDS) assessments. The initial diagnoses will set the bar for payments going forward and must be supported by clinical documentation each step of the way.
An application like ABILITY CAREWATCH® can help ensure accuracy by catching inconsistencies in your assessments before they are submitted. Providers can also analyze this data to improve care plans and locate reimbursement opportunities that may have been missed.
One such opportunity that PDPM incentivizes is accepting more medically complex patients, since reimbursement will be more closely aligned with their elevated care needs. Your staff must be equipped to deliver that level of care.
Expect that some staff training will be required prior to meeting the updated requirements for both the MDS assessments and the needs of patients requiring enhanced care.
Become or enlist an ICD-10 coding specialist
CMS’ FAQs note that ICD-10 codes will be used in two ways: First, providers will be required to report the patient’s primary diagnosis on the MDS. The diagnosis will be mapped to a clinical category and then further classified into therapy components.
Second, ICD-10 codes will be used to capture additional diagnoses and comorbidities of the patient, which factor into further classifying them into speech-language pathology and non-therapy ancillary components.
Many skilled nursing facilities don’t have certified coders on staff. Coding will be even more demanding under PDPM, and providers have a choice: either train key staff on the new requirements or consult with a certified coder.
Prepare to step down therapy use
One of the largest changes in the shift to PDPM is that reimbursements will no longer pay per therapy minute. Skilled nursing operators might consider renegotiating with their current therapy partners.
The new rules also limit group and concurrent therapies to no more than 25 percent. CMS considers this an important step to help ensure that patients receive the highest level of personalized care.
Don’t forget about your vendors
Skilled nursing facilities rely on many other service providers to run smoothly. Therapy providers, electronic health record vendors and others should be knowledgeable of the upcoming changes that PDPM will bring. Check in and make sure these providers are preparing diligently and sharing their progress and insights along the way.
One of the best ways to succeed under PDPM is to stay informed and prepare, so that when October comes, your facility can hit the ground running.
Claims denials happen throughout the revenue cycle, but often their origins are at the very beginning, the moment a patient seeks treatment.
What’s driving the denials?
According to the Journal of Healthcare Information Management, 86 percent of healthcare industry mistakes are administrative[i]. It’s not surprising when you consider the volume of paperwork faced by front-office staff, and what in many organizations is still a heavily manual workflow.
The Technology CEO Council found that patient charts cannot be found on 30 percent of patient visits[ii]. Without this vital information, basic patient data and benefit eligibility information are missing, leading to claims mistakes and denials.
Unfortunately, eligibility questions aren’t the only problem. In order for claims to be accepted and paid promptly, they must legible, accurate and complete – a tall order considering the number and complexity of diagnostic codes and the pace of regulatory changes.
Denials cost more than you think.
Trying to recover lost revenue can be a lengthy and expensive process, but worth the effort for providers. In the second quarter of 2016, the average automated claim denial from Medicare’s Recovery Audit Program was worth $714. And complex denials that required medical record review averaged $5,418[iii], according to the American Hospital Association.
With so much at stake, preventing mistakes from happening in the first place and avoiding denied claims is the best approach. But how? First, identify the real reason claims are denied:
People make mistakes.
We are human, and sometimes we make mistakes, no matter how good we are at our jobs, or how great we are as people. When you mix our humanity with a very complex healthcare system that is constantly changing — it’s no wonder errors happen. But it doesn’t excuse us from seeking a better way to complete this process.
It’s an easy fix.
Here’s the good news: most revenue lost along the revenue cycle is preventable through automation. And the majority of claims that are denied don’t have to be.
An automated system with a built-in claims scrubber, custom business rules and pre-submission eligibility checks can help ensure the cleanest claims possible. It can also keep up with current diagnostic codes so your staff doesn’t have to.
Imagine having a first-pass acceptance rate of 98 percent. It’s possible with ABILITY EASE® All-Payer, a software application that also helps eliminate the administrative burden of submitting secondary claims.
When it comes to revenue cycle management, it really pays to do it right the first time. Advanced technology makes it possible.
[i] Journal of Healthcare Information Management, Volume 17, Number 1, Winter 2003, https://www.himss.org/jhim/archive/volume-17-number-1-2003.
[ii] Technology CEO Council, A Healthy System Report, 2006, http://www.techceocouncil.org/clientuploads/reports/A_Healthy_System_Final.pdf.
[iii] Jacqueline LaPointe, Hospitals Still Facing Medicare Claims Denial Management Issues, October 17, 2016, https://revcycleintelligence.com/news/hospitals-still-facing-medicare-claims-denial-management-issues.
Revenue cycle management should be a priority throughout the patient’s journey — from the moment a patient walks in to receive healthcare services, to the moment that patient pays their final bill. There are many opportunities along this journey for healthcare providers to make their revenue cycle more efficient and productive.
These “big-picture” tools help along the way: clear communication, top-notch staff training, superior organization and state-of-the-art technology. But this high-level, simplistic view of revenue cycle management just scratches the surface when it comes to Medicare claims.
When your revenue cycle management journey includes Medicare, you’ll often experience detours, obstacles, errors, stalls and redirects. (And sometimes you have to do it all over again.)
The job of advanced technology is to make this journey as smooth as possible. Simply put, technology’s main goal is to improve revenue cycle management. This includes such things as: eliminating redundancies, reducing or removing human error, easing frustration and getting that final bill paid quickly and correctly.
What are the best ways to get your Medicare claims to the finish line? Are there ways to save time and money along the way? Here are three tips to help simplify Medicare claims:
Tip #1 Use your time wisely.
It seems like every week there is a new rule or regulation from CMS. Keeping up with these changes is a job in itself. When preparing documentation for Medicare claims, who has time to do anything more than once?
CMS continues to toughen its claims scrutiny, and organizations could see an increase in post-payment reviews. Plus, changing payment models are boosting the number of denials and the need for appeals.
Your time is important. Automate your most time-consuming processes: submission and tracking of ADR responses, RAC audit information and appeals.
Tip #2 Pass on paper.
These days, stationery stores have all but disappeared, but the healthcare industry still loves (and uses a lot of) paper. Did you know 50 percent of healthcare claims are filed are on paper? This can result in errors and wasted time.
Paper wastes a lot of money, too. A recent CAQH Index® report shows a staggering $8.5 billion is being wasted on medical providers’ manual transactions.
Reduce your overhead and save time by eliminating paper, printing and mailing costs. Instead, submit your Medicare documentation using secure, HIPAA-compliant electronic delivery.
Tip #3 Let technology do the heavy lifting.
Technology plays a critical role in successful claims management. It can streamline your process for secure submission, tracking, and reporting for Medicare claim review programs, and even help ensure proper reimbursement.
Medicare claims offer unique challenges that only the most adaptable, comprehensive and robust application can handle. Applications like ABILITY AUTOMATETM esMD manage Medicare claims and make the process a whole lot simpler for you.
How can your post-acute care facility stand out in a saturated and highly competitive healthcare market? By improving your quality care levels, you can make your organization more attractive to referring hospitals in your area. When they see that you have a lower readmission rate than competing facilities, they’ll put your name at the top of their referrals list.
Thanks to the changing reimbursement models, hospitals are feeling a lot more pressure from the Centers for Medicare & Medicaid Services (CMS) to lower their avoidable readmission rates. Readmission rates above a certain threshold will significantly reduce the revenue hospitals receive from Medicare reimbursements. Understandably, they’re re-evaluating how they choose their post-acute partners.
While big market shifts like this can be disruptive — and a little scary — they also present an opportunity. How can you stand out and show that your quality of care is better than the competition? First, you need to accurately track patient data.
According to a recent Rev Cycle Intelligence article, hospitals are now implementing utilization management programs, which “verify that patients are receiving the right care at the right time [ensuring] that hospitals are delivering appropriate, cost-efficient care.” Thanks to more accurate patient data tracking, these programs empower hospitals to improve care and reduce claims denials. Post-acute providers can use the same kind of data to improve quality care levels.
Know your readmission rate
When you have the right tools, you have the power to provide the right care at the right time, for better patient outcomes and higher quality care levels. Implementing an effective application to track hospital readmissions gives you a better view of your current performance. You can see where you are exceeding expectations and where you may have room for improvement.
Identify areas for quality care improvement
Better yet, when you can see condition-specific statistics, you can get a more complete view of your quality of care for all your patients. With these insights, you’ll see where you have a competitive advantage to target hospitals in your area that need post-acute care facilities like yours.
If you can identify areas where you excel and areas that need improvement, you can create an effective strategy to gain more referrals. Not only will you have the opportunity to continuously improve patient care, you’ll also likely increase your market share in the process.
Compare your quality care performance with your competitors
One of the most important metrics that referral partners evaluate is readmission rates. Tools like ABILITY INSIGHTTM Readmission Tracker use your patient data to benchmark your performance against your competitors. You can see where their quality care levels fall short, helping your organization stand out in the competitive post-acute care market.
Billing mistakes can cost your organization a lot of revenue. From increased days in A/R to claims rejections, you may be surprised at just how much money you’re leaving on the table. Fortunately, though, you can accelerate A/R days, reduce rejections and greatly increase your clean claims rate with just a few simple, yet highly effective strategies.
Always verify patient information and insurance benefits
First, whether you’re handling billing for a patient for the first time or you’ve been treating them for years, you should always verify their information and their insurance benefits up front. A patient may have moved, changed jobs or their benefits may have changed. These changes can easily result in rejections or denials and delay payment.
Significantly reduce billing mistakes by taking the time to double-check patient information and insurance coverage before submitting a claim.
Eliminate repetitive tasks
You may be wondering where you’ll find the time to verify every patient’s information. Fortunately, those verifications don’t have to add extra work when you can put technology to work for you. This next tip will help you save a lot of time while you say goodbye to even more billing mistakes.
With the right application, such as ABILITY EASE® All-Payer, you can eliminate repetitive tasks. For example, this application gives you the power to perform batch eligibility checks and run multiple payers and patients in a single session. So, you can ensure that you’ve verified patients’ benefits information while also significantly decreasing the burden on your billing staff.
Check against the most up-to-date rules
Checking against out-of-date rules will inevitably lead to more claims rejections and denials. Unfortunately, those rules can change on a quarterly, weekly or even daily basis. Your claims management tools should update in real time to ensure that you have visibility into the latest rules. With more clean claims, you’ll see a reduction in billing mistakes and decreased days in A/R.
Address potential eligibility issues up front
If you aren’t sure if a patient — or group of patients — is eligible for certain benefits or coverage, you leave yourself open to claims rejections. Your staff has to deal with the hassle of tracking down those claims and trying to determine what was wrong.
Claims management tools should easily integrate with eligibility verifications to allow you to catch mistakes early, before the claims go out. This saves an enormous amount of time and will likely result in an increased clean claims rate and more revenue coming back to your organization.
Use the right tools for faster correction guidance
When billing mistakes do happen, you can decrease their impact with an application that gives you fast correction guidance. Gone are the days of manually finding the reason for rejections, and then submitting appeals or contacting payers individually. An automated application can route that claim right back to your work queue with a clear message about the corrections needed.
The first step to optimizing your revenue cycle is to correct billing mistakes before they cause revenue problems.
For more tips to streamline your billing processes, visit the billing and claims management page on the ABILITY resource center.
Staff turnover can sometimes have a snowball effect. One person becomes frustrated or unhappy and leaves the organization, followed by another and so on. Turnover and instability (real or perceived) can breed anxiety among the remaining staff. What begins as a single event could progress into a toxic work environment and patient care will ultimately suffer.
There is usually no single issue that leads to high turnover. While each organization has unique challenges, staff scheduling difficulties are among the most frequently-cited contributing factors, especially in healthcare.
This is where an interactive application like ABILITY SMARTFORCE® Scheduler can make all the difference. Several of the frustrations surrounding scheduling are eliminated when you make the switch from paper to electronic scheduling. Read on to discover how the latest innovations in healthcare staff scheduling can improve staff morale and reduce turnover.
Staff are active participants in scheduling
Interactive, cloud-based scheduling engages staff in the process, leading to greater overall satisfaction. Employees can view schedules, pick up extra shifts, swap shifts with coworkers or request PTO, all from their mobile device.
This is especially important as the healthcare workforce continues to skew younger. The bulk of their communication happens electronically, and they appreciate the opportunity to interact with coworkers and management in a casual way. The interactive platform can even be used for shout outs and well wishes for birthdays and anniversaries.
Easing the burden on schedulers
There are a lot of variables to keep in mind when creating a schedule – managing overtime, accounting for time-off requests and ensuring that staff are properly credentialed for their assigned shift locations/ departments. A cloud-based, electronic application ensures you have the information you need for fair and accurate scheduling at your fingertips.
Schedulers no longer have to spend their day on the phone trying to get shifts covered. With one text, they can send a notification to the whole team about open shifts and staff can respond immediately. This convenient alert system eliminates the need to call employees on their day off and guilt them into coming in, a common complaint from healthcare staff.
Data that does the calculations for you
In a hospital setting, schedulers know that a Saturday night in the emergency room is generally much busier than a Tuesday afternoon. In a skilled nursing facility, the number and conditions of patients can also fluctuate. Instead of being thrown by these variations, be prepared with custom templates based on patient volume.
In an electronic scheduling platform, data can be aggregated and used to predict staffing needs based on a number of criteria, saving the scheduler a significant amount of time. Striking the right balance ensures happy staff and the best possible patient care.
Turnover is an expensive problem. A simplified, streamlined scheduling process is an easy way to address some of the most common contributing factors, ensuring increased satisfaction for both staff and management.
After years of delays, the process for verifying eligibility will soon change for healthcare providers throughout the country. CMS is migrating hospital, home healthcare, hospice and skilled nursing (Part A) eligibility inquiries from the Common Working File system (CWF) to the HIPAA Eligibility Transaction System (HETS) in the fall. After that time, providers will no longer be able to access CWF to verify eligibility. The transition will not impact access to the CWF for claims management.
Healthcare providers who want to verify Part A Medicare eligibility benefits will be required to use a National Provider Identifier (NPI) that is registered in the Medicare Provider Enrollment and Chain/Ownership System (PECOS) database. As part of the eligibility process, these eligibility applications will verify that the NPI used on the inquiry is present in the Medicare PECOS database.
What to expect
Whether you work in an acute or post-acute setting, the change means that inquiries made with NPIs NOT present in the Medicare PECOS database will fail to return Medicare eligibility data. To avoid verification disruption, it’s critical that you review the PECOS status for any NPIs currently used by your organization. If your NPIs are not currently registered with PECOS, update that information accordingly. Additional information on PECOS and how to register your NPI can be found here.
What if your organization uses HETS, or uses both HETS and CWF for eligibility verification? If you’re already using HETS, there’s nothing you need to do. If you’re currently using both systems, you should start using HETS exclusively.
How we got here
CMS first signaled plans to discontinue eligibility checks through CWF in December 2012, announcing that HETS would be the single source for this data. After receiving feedback about – and later resolving – the differences in data returned from the two systems and the one-year limit to HETS historical searches, CMS is now moving forward with the transition to one system.
ABILITY® has you covered
As was the case in previous CMS transitions, ABILITY is well prepared to make sure healthcare providers experience no disruption.
For ABILITY EASE® Medicare, ABILITY CHOICE® Medicare Eligibility and ABILITY COMPLETE® customers, the transition is a non-event. Providers can continue to verify eligibility in CWF until CMS requires the move to HETS. From there, ABILITY will manage the transition to HETS to ensure a seamless transition for the customer. It’s one of the many ways ABILITY helps simplify complexity for its customers.