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Checking against out-of-date rules will inevitably lead to more claims rejections and denials.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.
Have you patted someone on the back today? Is that a regular occurrence at your organization? Employee recognition or “shout outs” can go a long way to improve staff satisfaction and retention – two key concerns in healthcare.
There are few things that generate a larger (or easier) ROI than staff recognition. It takes very little time, but can shift the direction of an individual’s day, or on a larger scale, staff morale as a whole.
See why it’s worth your time and consideration to add shout outs to your workforce management strategy.
It couldn’t be easier
Let’s be honest, we’re all busy. But how long does it take to thank someone for picking up an extra shift at the last minute, or acknowledge a team member who went the extra mile to finish a task?
There are many ways to incorporate shout outs into your management strategy. It doesn’t cost a thing but generates significant goodwill. Workforce management is about more than just hiring and managing staff. A healthy workforce is a happy one.
People work harder when they’re appreciated
No one likes to feel taken for granted. We want to know our contributions are valued. Validation feels good, and studies have consistently shown that staff will work harder for recognition than for money. Healthcare is a difficult, and often thankless, industry. But by taking deliberate steps, you can change that within your organization.
Staff will stay put
Employee retention is top of mind in the healthcare industry. Long hours, complex working conditions and burnout can all contribute to high turnover. Replacing staff is expensive and time-consuming, and if they stay despite being unhappy, you may have an even bigger problem. Their pessimism can be a drain on morale.
While it’s not possible to please every staff member all the time, a genuine show of appreciation goes a long way to promote a positive attitude. Staff satisfaction and engagement can permeate a workforce as easily as apathy.
Your workforce management strategy determines the course. It’s easier to promote a positive atmosphere from the beginning than to claw your way out of a quagmire of discontent. Fortunately, technology can help you show gratitude and publicly recognize the accomplishments of staff. ABILITY SMARTFORCE® Scheduler, for example, is an easy-to-use software tool that features shout outs on its mobile application.
Say thank you early and often. Recognize staff accomplishments in groups and one-on-one. Employees are less likely to leave if they think they’ll be missed.
Predictive analytics can do a lot for your facility. With a deeper, more accurate view into your billing patterns, you can see trends in billing mistakes, claims denials and other patterns that may cause delays and other problems in your revenue cycle.
Traditional analytics applications give you a look back at things like your billing, care required, care provided and reimbursements. While these insights are no doubt useful, they inevitably come with a delay. With analytics, you can leverage the power of machine learning and big data to identify trends and unintended billing patterns before claims are even submitted.
So, how can you implement analytics to track and improve your billing cycle?
Predictive analytics and insights in the shift to value-based care
In the transition to alternative payment models (APMs) and other value-based care reimbursement models, you will no longer simply bill patients and residents based on the services you provide. Rather, your reimbursements will depend on several factors, including the quality of care you provide, patient experience and patient outcomes.
This shift in billing and reimbursement models comes with new billing patterns and the opportunity for more mistakes. However, by recognizing and analyzing past billing mistakes, you can adjust accordingly to submit more clean claims the first time around. Using the latest technology to triple-check universal billing (UB) and other claims, you can create better continuity between the care you provide and the reimbursements you receive. And, by automating manual processes — such as the time-consuming UB-04 check — you can save time and labor for your billing staff, as well.
Better insights: Minimizing audit risks and increasing revenue
Monitoring and analyzing your billing cycle will make it easier to spot examples of when the underlying MDS does not support your billing, or vice versa. Getting this feedback and insight early and having the opportunity to correct it prior to submission can help your facility avoid an audit.
At the same time, you may find treatment listed in the MDS that was missed on a claim. The opportunity to make these corrections early will result in more accurate claims that represent higher reimbursements for your facility. And accurate, clean claims also tend to get paid faster.
Using analytics to track your billing trends is exceptionally valuable, especially when it turns up new opportunities for increased reimbursement. With a tool like ABILITY UBWATCH®, you can coordinate financial UB records, potentially increase reimbursements, accelerate A/R and guide your facility toward continuous improvements in billing and patient outcomes.
Better billing practices and increased cash flow are within reach. Check out our application landing page for tips that can transform your revenue cycle management.
The patient-driven payment model (PDPM) goes into effect in just a few months. Skilled nursing facilities (SNF) have until October 1 to make the transition. Is your facility ready?
Established by the Centers for Medicare and Medicaid Services (CMS), PDPM represents a shift from fee-for-service care to value-based care models. Successfully transitioning to PDPM will involve a three-pronged strategy for SNFs:
- Optimizing efficiency in providing care
- Enhancing patient experience
- Improving patient outcomes
In a value-based care model such as PDPM, instead of billing patients based on the number of services you provide, you’ll bill them based on their outcomes. They key to maintaining revenue during this transition lies in capturing and managing data.
A deeper look into each step of the transition strategy, as well as how to best use the data you collect, can help your facility transition to PDPM without missing a beat.
Optimizing efficiency in providing care
When you optimize how you care for your residents, you may find untapped, justifiable reimbursement revenue that you would have otherwise left on the table.
With ABILITY CAREWATCH®, you can use the Resource Utilization Group (RUG) Potential tool to view RUG groups before you transmit your assessments. This will allow you to plan ahead for the next Minimum Data Set (MDS) assessment and ensure that you are properly reimbursed for each resident’s care and the services you provide.
Enhancing patient experience and improving outcomes
When your organization is reimbursed based on the quality of your patients’ experiences and outcomes, data becomes an indispensable tool. The right data applications help you keep track of where you stand on crucial quality measures. Tracking your Five-Star rating, for instance, allows you to clearly see how your facility compares with others, where you are succeeding and where you need to improve.
Another important metric to watch is acute care readmissions so you can identify at-risk residents. Data-driven applications offer SNFs the opportunity to pinpoint exactly where they need to improve for a seamless transition to PDPM.
Accurate MDS assessments for better reimbursements
Also, to improve patient experience and outcomes, SNFs must have the power to create enhanced care plans with accurate analysis of the MDS. With the right tools, you can catch MDS issues early and boost assessment accuracy for better care plans. With accurate MDS assessments, you’ll also be empowered to find more reimbursement opportunities, ensuring that you collect more of the revenue that you are owed.
Data-driven applications are crucial to easing your transition to PDPM and helping you improve patient outcomes.
For more resources on transitioning to PDPM, as well as other relevant industry info, visit the ABILITY resource center.
Value-based care is all about doing what’s best for the patient and promoting better outcomes. This method of care uses patient well-being as a guide for payment, rather than the number of procedures or drugs prescribed. It represents a shift from a fee-for-service to a fee-for-performance model.
It’s already impacting how providers create at-home care plans, conduct treatment follow-ups and manage their quality care levels. Additionally, this industry shift is affecting the admissions process and patient pay procedures, emphasizing the need to best serve patients during the entire treatment cycle.
Here are three ways value-based care is causing providers to rethink standard payment practices.
Providers can (and should) make patient pay easy
When was the last time you visited an establishment that didn’t take credit cards? Or, as is the case with airlines, a place that refused to take cash? Offering limited payment options is inconvenient and often stressful for consumers. The same is true for patients, who increasingly are adopting a consumer-like mindset about their healthcare.
Part of caring for your patients means making the payment process easier to navigate. Not only should you strive to offer several options at the point of service, but also make off-site options available, including online payment portals and automated, recurring payment plans. Allow them to conduct business their way, on their schedule, even if it’s in the middle of the night. Life isn’t limited to business hours; patient pay options shouldn’t be either.
How the payment process affects patient care
It’s a safe assumption that when your attention is pulled in multiple directions, you’re not approaching every task with peak efficiency. Though patient care is always a top priority, billing and other administrative tasks still need to be done to keep things running smoothly.
That is where automation, like that offered by ABILITY SECUREPAY®, can transform how your organization operates.
Automation tools offer business office features to help you post, refund, manage and track payments, saving everyone time and frustration. With the administrative burden lifted, your staff is able to be present, focused and provide better patient care.
Patient experience and outcomes matter
The overall patient experience extends far beyond in-person interaction. No matter how attentive and responsive you are to patients when they receive care, their journey is only beginning. They are left to wonder if their treatment is going to work and how long it might take, as well as how much it’s going to cost.
Anxiety caused by rising co-pays can also cause patients to delay seeking treatment in the first place, possibly allowing their condition to worsen.
Providers who make any part of a patient’s experience easier, faster or less stressful are going to provide better outcomes and encourage patient loyalty.
Providing excellent patient care means more than just scheduling check-ups and following a treatment plan. It also includes things like not making them wait and wonder if their payment will post on time, or when their refund will arrive. Automated patient pay tools can save you time that would be better spent helping patients understand all of the available payment options, so they can select the method they are most comfortable with.
Patient treatment begins the second a new patient makes an appointment. It continues as they interact with admissions staff, billers, care providers and specialists. No matter who they’re communicating with, patients need to know your team has their best interest in mind.
As a result, it’s your responsibility to enhance the standard treatment experience. You must find ways to make treatment not just effective, but also as personal and enjoyable as possible. Advanced patient pay practices can help. They turn an experience that is sometimes stressful, confusing and outright intimidating for patients into a much more manageable, satisfactory aspect of treatment.
Here are three patient pay improvements that can significantly enhance your patients’ treatment experience.
1. Offer a convenient way to pay
When was the last time you used cash to pay for groceries, gas or your home electric bill? If you’re like most consumers, you probably prefer to use your credit or debit card, or maybe a mobile payment app, when making everyday purchases.
Your patients are also accustomed to using modern forms of payment, and many of them see these methods as a more convenient, easy-to-use alternative than cash or check. This presents a key opportunity to enhance the treatment experience by implementing an advanced payment system like ABILITY SECUREPAY®.
Give patients the option to pay for their medical services the same way they pay for other goods. Show them that you’re focused on meeting their needs in every possible way. Then, watch as patient satisfaction increases – and, potentially, as A/R days for patient payments decrease. When patients are able to use a credit card to pay online or over the phone at their convenience, they’re more likely to pay on time as opposed to when they’re limited to using other methods.
2. Let patients pay for services over time rather than all at once
A recent study found 64 percent of patients delay or skip care because of costs – leading to even more costly care situations. These may include:
- Emergency room visits
- Increased hospital readmissions
- Unfavorable treatment outcomes (causing the need for repeat/additional treatment)
While money isn’t the only reason patients hesitate to seek treatment, it is a significant concern for many. This is why payment plans are so valuable. They make treatment more accessible and ease the fear or anxiety often associated with payments. And with an increasing rate of patient payment responsibility, the more you can do to help patients manage their payments, the better off their health (and your bottom line) will be.
3. Give patients the option to set up recurring payments
If patients do decide to sign up for a payment plan, make it even more manageable for them by offering automated recurring payments. Just like paying for home utilities or a phone bill, recurring payments for medical services can simplify and enhance the patient experience. They give patients one less thing to worry about, allowing them to focus on the at-home care plan you’ve provided for them, the medication they need to take, or the lifestyle changes they’re working on.
Just as your team manages claims and payments to increase organizational financial performance, your patients make personal finance decisions every day – some more difficult than others. Make the decision for them to seek treatment and pay for services an easy one. Support their payment process by implementing advanced patient pay practices to enhance their entire treatment experience.
It’s hard to plan long-term care improvements when you’re focused on the immediate needs of the present. Between attending to patient emergencies, making time to see new patients and managing the day-to-day workflow of your skilled nursing facility, there’s practically no time to sit down and anticipate future needs.
This is just one reason why predictive analytics and insights are invaluable in healthcare. While you and your team are busy handling daily responsibilities, advanced systems can work in the background to track your activities as well as patient behaviors. Then, when you have time to make sense of the data gathered, you can identify actionable steps to implement.
These can influence many parts of your day-to-day, but they have one common purpose: to improve the standard of quality care you’re able to offer patients.
Here’s a closer look at three of the long-term patient care improvements you can accomplish by utilizing predictive analytics and insights.
1. Reduce the risk of incidents
Why did one of your patients recently experience a fall? What was it that caused another individual to mistake their medication? How often do these things occur?
These are just a few of the questions that data can help you answer. When you give your staff the capacity to track every detail of an incident, you collectively lower the risk of future incidents. The information recorded highlights areas of care you can improve to better prevent negative patient experiences. It also provides full visibility into incidents that have already occurred, which can help you prioritize which patients now require the most attention.
2. Increase intake of patients with conditions you specialize in
As beneficial as it is to record and analyze activities within your organization, you also need to keep an eye on what’s happening in your market.
Having market data accessible at your fingertips greatly improves your competitive advantage. It gives you the information you need to target the best potential referral partners – like hospitals who are releasing patients with conditions you specialize in.
Instead of reaching out to hospitals at random, a tool like ABILITY INSIGHT™ Referral Mapper offers detailed reports on local hospital releases and recent admissions by competing post-acute facilities. Analyzing the data allows you to identify the best opportunities in your local market. And by creating targeted partnerships, you’re setting your team up to succeed in the areas of care they’re most familiar with.
3. Track and monitor quality measures
The final way that predictive data and analytics can improve patient care is by helping you monitor quality measures. As you’re tending to patient needs, intaking new patients and releasing others, predictive analytics and insights can make sense of your day-to-day activities. They’ll generate reports to identify how you can positively impact your quality measures, and help you track that progress over time. With the right tool, you can even benchmark improvements against state norms and competing facilities.
The benefits of analytics aren’t limited to patient care. Once you discover how to capture and make sense of all the data available to you, the opportunities to improve performance – from patient care to workforce management – are endless. Don’t wait any longer to take advantage of this information. Invest in the predictive analytics and insights you need today to offer more successful patient interventions tomorrow.
Imagine if you went into a patient visit knowing that you wouldn’t receive payment for your work. Would you invest as much time on that patient? Would you hope to see their name on your schedule again?
Compare this scenario with one in which you know for a fact that you’ll receive payment. Most healthcare professionals would choose the latter. However, many hospitals and facilities receive payment rejections on a regular basis. As much as you want to provide every single patient with the best possible treatment, you also need to make sure you’re collecting all the projected revenue associated with your work.
If you’ve been seeing a spike in rejected payments, it’s time to reassess your revenue cycle management efforts. Try using these five tips to help prevent rejected payments.
1. Clean up your documentation and coding process
In a recent HIMSS Media survey, 41 percent of respondents said clinical documentation and coding is a high-risk area for losing revenue, and 43 percent of respondents considered it a medium-risk area.
If you agree, put a stronger emphasis on correct coding. Invest in employee training to ensure that everyone understands the codes your team is working with. Or, try scheduling more people per shift so your team isn’t spread thin and is less likely to make mistakes.
These are just a few ways to improve coding efficiency. If coding errors are affecting your organization, you can’t afford to overlook this issue any longer.
2. Send claims in batches rather than one by one
Sometimes, payment rejections occur because a claim has been submitted to the wrong payer. Additional reasons for rejections include:
- Inaccurate or missing patient information
- Inaccurate payer information
- Terminated coverage
- Timely filing deadlines
- No referral on file (for applicable services)
Batches can’t solve all these issues, but they can offset the chances of payment rejections. Working in batches means you can group claims by payer. It reduces the risk of sending claims to the wrong payer and helps you file claims in a timely manner.
Thanks to the digital systems that make working in batches possible, you’re also able to prevent inaccurate or missing patient information as you work through each claim in your batch. Think of your eligibility and claims management system as your second set of eyes. It will tell you if there’s any adjustments you need to make in any claim within a batch. When you have no notifications, you can trust that every claim has all the information it needs to be accepted.
3. Consolidate your claims management
Speaking of eligibility and claims management systems, how many different revenue cycle management tools do you use? Do you have one filing process for Medicare and Medicaid payers, plus a separate way of submitting claims to private payers?
This kind of workflow only increases your risk of rejected payments. On the other hand, using a single portal like ABILITY EASE® All-Payer to communicate with payers makes your RCM more efficient. It increases the accuracy of each claim you make, and helps you catch any mistakes before a claim is submitted.
The result? A faster, cleaner claims management workflow.
4. Track your audits and appeals
Although automated tools can significantly increase claims efficiency, they can’t guarantee first-time acceptances for every single claim. Make sure to track your audits and appeals whenever you find yourself resubmitting claims.
This provides full visibility on all your outstanding payments. It allows you to track financial performance metrics and hold your team accountable to the goals you’ve established. It can also help you adjust your financial strategy if necessary.
5. Save patient data
The final tip to help you decrease rejected payments is to save patient data. This will significantly improve the accuracy of every claim you create, in addition to speeding up eligibility verifications and claims submissions.
Note, this doesn’t mean you should keep storing paper files for all your patients. The better option is to save patient data within your claims management portal. This way, all you have to do to create a new claim is click a few buttons. You can quickly pull the information you need and trust it’s accurate, rather than waste time sifting through piles of paperwork and double-checking everything manually.
There’s no reason to keep letting rejected payments add up, or to spend hours on revenue cycle management. Start using tips above to improve your chances of receiving full payment with a faster, more accurate workflow.