Best practices, tips, education, lessons learned — helping healthcare professionals advance their work

What is revenue cycle management in healthcare?

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.

How Telehealth Services Can Be Crucial to Your Revenue Cycle Management Strategy

We’ve been hearing it for weeks: Stay at home, social distance, avoid close contact with others, all in an effort to curb a global pandemic. The rules are a bit different for healthcare providers.

In addition to pandemic-related illness, people will continue to require medical care for a variety of reasons. As a provider, you’re challenged to protect your staff and your patients and still provide quality care.

Enter telehealth services.

With telehealth services, patients receive care (or a broad range of other services) from their providers without traveling to a healthcare facility. Even before the emergence of COVID-19, these services were gaining popularity from a convenience standpoint. In our current state, they have become an essential part of a provider’s revenue cycle management strategy.

Supporting your revenue cycle with empty waiting rooms

To help providers continue to care for their patients, the Centers for Medicare & Medicaid Services (CMS) has made allowances and broadened access for telehealth services.

  • Under the 1135 waiver, patient eligibility for telehealth services will no longer be limited by location
  • The originating site requirement is eliminated
  • Physicians, nurse practitioners, physician assistants and other limited license practitioners can provide services

Telehealth makes it possible for providers to operate and collect revenue without face-to-face office visits. Even HIPAA enforcement has been relaxed and penalties waived for providers operating in good faith.

Getting started with telehealth

Regulatory changes aside, you may wonder how to begin offering telehealth services through your practice. Questions about which platform to use, how to collect patient copays and how to capture the correct insurance ID (or MBI for Medicare beneficiaries) can seem overwhelming without the appropriate tools.

Once you decide which platforms to use, you’ll need to communicate this new option to your patients and ensure that your staff is knowledgeable on how to operate them.

To support an efficient workflow for your staff, ABILITY Network offers powerful applications for eligibility verification (including tools that return patient MBIs), Medicare claims management and patient payment collection, to keep your revenue cycle moving.

For the foreseeable future, telehealth services will be essential to keep your practice moving forward. Partnering with a single RCM provider like ABILITY can help simplify the journey.

To learn more about telehealth services, don’t miss this on-demand webinar presented by medical practice management expert Kem Tolliver.

staff retention

3 Staff Retention Strategies You Need to Start Using

As of 2017, the average rate of healthcare staff turnover was 20.6% – a number calculated out of 11 million employees in an array of different healthcare markets and job functions.

From 2017 to now, the healthcare market has only gotten more competitive, which gives employees an advantage while putting pressure on employers to prioritize staff retention. Every time a person leaves your organization, it comes at a high cost. Between the overtime it takes to fill in shifts, the stress that under-staffing puts on your team and the cost of onboarding new talent, you risk losing a significant amount of time and money each year if you don’t focus on staff retention.

Here are three simple, yet effective staff retention strategies to utilize.

1. Continue onboarding beyond the first week   

The onboarding process spans well beyond a new hire’s first week. It’s a process that should be carefully thought out and include an equal level of engagement from supervisors and the new employee.

A healthy onboarding period lasts about 60-90 days. This gives new hires a chance to truly get a feel for the organization. It’s their time to take on all the job functions within their role, get to know colleagues and present fresh ideas to their managers. From a leadership perspective, 60-90 days is a great time to learn a new hire’s habits. It provides a glimpse of how often an individual may show up early or come in late, call out or pick up extra shifts and/or earn recognition.

In terms of staff retention, think of a new hire’s first few months as the company’s first impression. You may have won them over during the hiring process, but you must ensure that the day to day operations and actions of others reflect what was discussed in interviews. Otherwise, you risk creating a costly disconnect.

2. Invest in professional growth

Don’t forget about a new hire once they’ve gotten settled in. In fact, make professional growth and development a priority for all the people you oversee.

This may mean you become more proactive about how employees meet continued education requirements. It might be the reason you start having more frequent one on one meetings or informally checking in with your team. Other growth opportunities include:

  • Inviting/sending staff to conferences
  • Bringing in industry experts for training opportunities
  • Offering leadership development and clear pathways for advancement

Talk to your team before you roll out any of these development initiatives. You want to make sure you offer what they really want, rather than risk acting on a false assumption.

3. Make a habit of coaching and recognizing others

Sometimes, encouraging employee growth is as simple as making a genuine connection with them. Culture is a big reason why people stay or leave their organization. You can offer all the training and development you want, but it has to be matched with a genuine concern and interest in your people in order to be effective.

Make it a point to recognize staff more. This can be something you start doing at the end of team meetings or you can develop a special retention program. It can have a competitive spin on it and recognitions can range from verbal shout-outs to special tokens of appreciation. Whatever initiative you come up with, make sure it’s received well. Don’t hesitate to adjust as needed and continue improving the program once you have a good recognition system in place.

There’s one more retention strategy worth mentioning: gather and learn from employee retention data. As you work to implement the strategies mentioned above, measure their impact. Notice what your team responds best to and find ways to build on these initiatives. The ROI of higher performance, more staff engagement and a longer average employee tenure will be well worth the time and money you invest in your team.

information overload

How to Prevent Information Overload in the Workplace

Between gathering and verifying patient data, keeping up with new regulations and managing the day-to-day operations of your organization, there’s a good chance your staff is experiencing information overload.

At some point, important details will slip through the cracks and miscommunication will become more frequent. This can lead to under-performance within your organization, as well as an increase in mistakes and staff burnout.

Luckily, this doesn’t have to be the case for your team.

Here are five things you can do to better prevent information overload.

1. Break down your emails

Most team communication emails cram updates, action steps and requests all into one message. To point out the “main ideas,” different words and phrases within one email may be bolded, underlined, highlighted or written in a color other than black. When all these differentiators are mixed together, staff members are left having to discern what information is the most important.

This kind of confusion can be avoided if you make it an organizational standard to send clean emails. Limit the important details within one email to two or three key points – ideally, they should relate to one another.

This may increase the number of emails you send to your team, but it will also increase how well information is understood and retained.

2. Make patient data easier to manage

Another tip to ease information overload is to simplify how you gather and manage patient data. This may include:

  • Offering new patients the option to fill out forms online
  • Giving patients access to a portal with all their payment and treatment information
  • Regular staff training on coding procedures and new rules and regulations regarding patient information
  • Providing continued training on how to improve patient interactions to better get to the root of their condition and explain their role in treatment more clearly

There’s often a gap between the information that a nurse/physician writes down at the start of treatment, the information another healthcare professional utilizes during treatment and how well a patient understands their condition. Aim to close this gap by being more clear and consistent. It will transform the kind of care your staff is able to offer and significantly enhance the patient experience.

3. Create a better patient data sharing process

If you often send patient referrals to other providers, or if most of your patients are referrals, you may want to improve how you share patient data. The more effective you are at communicating patient information, the more successful treatments will be.

When miscommunication occurs between providers, it causes a costly inconvenience for patients. Individuals are left having to track down their healthcare information from various offices before their treatment can move forward. This delays care, hinders quality and can increase a patient’s risk for other conditions to occur.

But, simplifying how you share and receive patient information can make their experience much better and relieve some stress from your team.

4. Minimize out-of-work texts and calls

How often do you find yourself texting staff members to fill in for shifts? Do you have a habit of calling people on their day off?

Such communication is highly detrimental. It doesn’t give your staff a chance to unwind from their work. It makes them more likely to burn out or leave your organization.

If you have an immediate need to communicate, do so over email or via your staff scheduling portal. Calls and texts make sense during emergencies, but most of the time, they just contribute to the information overload your staff experiences every day – on and off the clock.

5. Ask for staff input

The final way to prevent information overload in your organization is to gather feedback from your team. Ask them how they feel about the current communication standards in place – both amongst the team and with patients. See what they’d like to have more training on and set aside time to come together as an organization. Staff engagement makes it much easier to eliminate confusion and to push forward new ideas. This also ensures you don’t overlook anything that needs improvement regarding the expectations you’ve set for your team and the patient data they work with every day.

Healthcare professionals are expected to provide personal, attentive care to everyone they treat, to drive innovation within their organization and adapt to industry changes. They can’t do this effectively if they’re always juggling information. Keep things clear and concise and watch how well your team – and their performance – responds.

workplace culture

The Key Pillars of a Strong Workplace Culture

Can you list your company values off the top of your head? Do you know anything about your team members beyond their name and what they do at the company?

If you answered “no” to either of these questions, your company culture is in trouble. Culture is the driving force of your organization. When it’s healthy and inclusive, your team produces amazing results. When the team is disengaged, they’ll do the bare minimum, make more mistakes and may even search for another job.

In order for your team to show up excited for work every day – to be fully engaged in their role, communicate well with others and push new ideas forward to make the organization better – you need to prioritize building a strong workplace culture. Start with a focus on these three things:

1. Appreciation

It’s one thing to understand the need for all team members to feel valued, but another to make a habit of expressing employee appreciation. It’s time to put a recognition process in place that works for everyone. It doesn’t have to be grand or time-consuming, but it should be effective and easy to engage with.

Maybe this means you set a daily or weekly all-team meeting for everyone to touch base. You can use this as a time to cover progress since your last meeting and open the floor for people to recognize their colleagues. Maybe you start a “high-five” communication channel within your scheduling platform or via another system. This can be a place for individuals to recognize one another at any time during the day.

In addition to an all-team effort, make it a personal commitment to appreciate your people more. Do walk-throughs in your place of work and stop to check in on people and personally thank them for their good work. Ask how you can be of service to them, too.

2. Enthusiasm

No matter what aspect of healthcare you focus on or how big your organization is, you should feel excited about the work you’re doing – especially if you’re a leader within the company.

Your work ethic sets an example for others. If you’re not engaged in meetings or taking ownership of your work, it makes people think they can act in a similar manner. But if you show up with a passion for work every day, you’ll instill that passion in others. Your workplace culture will naturally become stronger; individuals will start to communicate better, work harder and create more impressive results.

To make sure everyone is as excited about work as you are, go a little further. Create a unique company saying or a tradition/habit for everyone to enjoy. There’s no limit to what this could be, just make sure it gets the message across loud and clear that your organization is a great place to work.

3. Opportunity

Team members at all levels need to know there’s a next step for them. Otherwise, they’ll start looking elsewhere to advance their career.

As such, it falls on organizational leaders to make sure there’s a clearly communicated path for growth. Growth does vary among different positions and individual interests, but there are still certain things you can do at a general level to make sure everyone knows new opportunities are available to them.

Talk through company-wide goals with the team(s) you manage. Explain how a person’s work contributes to bigger initiatives in one-on-one meetings or when offering that personal note of appreciation mentioned above. Get involved in individuals’ goal-setting processes if you have the time available.

The more you invest in your team members, the more they will give back to you. It’s that simple, and it plays a critical role in the strength of your workplace culture.

improve employee engagement

Employee Engagement and You: What Leaders Can Do to Motivate Staff

No matter the kind of healthcare organization you run, you can’t do everything on your own. But to rely on your staff to perform at their best, you must establish a strong, consistent level of employee engagement. Each person on your team should show up to work excited for the shift ahead of them. They should feel a connection to their purpose within the organization, a sense of comradery with other staff members and be comfortable to speak up when necessary.

If you’ve been dealing with consistent tardiness, dropped shifts or frequent mistakes, your staffing challenges are likely more serious than you think.

Here are five ways to elevate employee engagement.

1. Share organizational goals

It’s easy for an individual to become disconnected with their work if they don’t understand the role they play within the group. As such, it’s the responsibility of organizational leaders to make everyone feel valued.

Make an effort to share high-level goals with all your staff members and cater the messaging to specific departments, if not to individuals. This will help every single staff member connect to their role. They’ll take on more ownership of their duties and have more pride in their work – two things that do wonders for employee engagement.

2. Encourage feedback from individuals at all levels

Just as you need to share your thoughts with everyone on your team, you should be asking for their input. Staff members rarely offer unsolicited opinions, which means it’s on you to remind each person they have a voice and encourage them to use it. Make it clear that comments and criticisms are welcome and valued by the team. This sounds simple enough, but far too many people keep comments to themselves which can lead to resentment and lack of motivation.

3. Praise in public, criticize in private

There’s a delicate balance between developing professionals with praise and with accountability. While it’s crucial to do both, it’s even more important to understand when each one is appropriate to give.

Always save criticism for private interactions. Don’t single out individuals within a group or place blame on them. Rather, pull them aside and turn a mistake into a coachable moment. Praise can be shared in private or in public. When offering either form of feedback, be as specific as you can about a person’s actions and their outcomes.

4. Remember personal details

One of the most effective ways to make your team members feel valued is to treat them as people, not assets. Make it a point to establish a healthy personal connection with the men and women on your team. Remember their birthday and work anniversary. Talk to them about their family and personal accomplishments, too.

This will increase the level of respect between you and each individual, and may lead to stronger staff relationships as well. When people start to see their colleagues as friends, they work harder and smarter together.

5. Implement an employee appreciation program

As you start to see engagement levels rise, keep the momentum going with an appreciation program. It doesn’t need to be costly or large-scale. It can be as simple as adding a shout-out feature to your scheduling program or spending five to ten minutes of a regular group meeting to share special recognition.

If you’re interested in bigger appreciation initiatives, create a company award for individuals to work toward or run team competitions throughout the year. Whatever you do, make sure it’s received well. You want your efforts to feel genuine and create effective engagement results long-term.

Boosting staff engagement should be an ongoing responsibility rather than a one-time effort. Ideally, you want your best people to stay within the organization for years, and you want good medical professionals to become the best they can be. This begins with you and how you position your team for success.

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SNFs must focus on star ratings to prep for 2017

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