Many hospitals struggle with revenue collections. There are some uncomplicated steps to increase hospital revenue with minimal change.
By: Samantha Geroli, Mindy Singer and Donna Tarsa
- Is obtaining your required collections more difficult than expected?
- Is your denial rate increasing while your payment rate decreases?
Estimates to Increase Hospital Revenue
Increase up front patient collections by providing accurate estimates of the cost during pre-registration or at time of service. This informs the responsible party of their probable payment and allows patients to set up a payment plan if they are unable to pay in full. Some facilities offer up to a 20% “Prompt Pay Discount” for patients who pay their estimated balance in full. Accurate estimates allow patients to better understand their responsibility prior to receiving their statement.
Training to Decrease Denials
Are you having increased denials for medical necessity, precertification, or patient demographics? These are common reasons for denials, and many facilities face these same struggles. Due to historically higher turnover in the patient access department, comprehensive training is difficult to achieve. However, dedicating a trainer and curriculum to patient access staff members can decrease denials and increase staff engagement and satisfaction. Ensuring an accurate registration is obtained at time of service is critical to denial prevention. Confirming patient legal name, date of birth (DOB), insurance order, group number, claims mailing address and obtaining a copy of insurance card(s) and governmental identification will reduce denials related to patient demographics. Additionally, checking if payor specific precertification’s or referrals are required prior to service will prevent denials for missing authorization. Other training on local coverage determination (LCD) and national coverage determination (NCD) guidelines is also helpful. Checking to see if the services scheduled meet LCD and NCD guidelines will decrease denials for medical necessity.
Tracking denials that happen because of these noted reasons is important so the benefits of the training program can be measured, and the staff recognized for their accomplishments.
Payor Updates for Increased Revenue
Change is constant in medical billing. Confirm you are actively reviewing payor bulletins for changes. Many payors update their bulletin boards in real time online as issues arise and as changes are made. Make both a calendar note and a mental note of January and October as this is normally when payors make covered service changes. Services that were once covered may not be after January 1st or October 1st. While some things change, others stay the same, such as your payor contracts. Many facilities do not take part in renegotiating payor contracts. This could be a cause of lost revenue. Be sure to monitor your contracts and payments to confirm you are being paid accordingly. While you should be on the lookout for underpayments, you should also check for over payments. Credit balances are common, so be sure you are equipped to identify them properly and timely. Untimely identification or resolution of credit balances can be considered a breach of contract. Confirm the payor is “happy” and report and correct credits as quickly as possible. Also, confirm the Medicare Credit Balance report is completed on time each quarter to ensure no payment disruptions.
Keep in mind when new providers come on board they will need to be credentialed with each payor. This is a very time consuming and tedious process, but without the proper credentialing no payments will be made.
Often times, it is difficult to ensure the accuracy of claims upon submission. There are many departments that assist in ensuring a claim is “ready” to be billed.
One of the first steps in claim accuracy is confirming the claim is coded correctly. A common issue that arises without coding review is up-coding or down-coding. If up coding or down coding occur, inaccurate payment will be received. Take the extra step to ensure all coding is correct prior to claim submission. Also, the diagnosis related group (DRG) must be checked on inpatient claims. Many facilities face recoupments due to inaccurate DRG coding. Once all coding has had the final review, it is time to send it on to its next review phase. No facility is perfect; therefore, claims are often stopped in the clearing house for additional edits. Medical necessity, medically unlikely edits (MUE) and coordination of benefits (COB) are some examples of the edits that can arise prior to claim submission. Confirm all edits are fixed prior to submission. Bypassing claim edits can cause denials in the future. Also, make sure claims are submitted on a daily basis. Daily submission of claims leads to daily revenue received. When the cash comes in, be sure to stay up to date on posting.
Motivating staff members can increase up front collections. Set monthly goals with incentives for staff members to compete in a little friendly competition. Giving gift cards or free lunch vouchers as incentives to staff members that exceed key performance indicators (KPI) performance will keep their focus on the goal.
How can you maintain a positive community image? Is it even that important to revenue cycle? Yes, and yes. Without the community there would be no revenue. Upholding a positive community image can drastically increase revenue. Happy patients speaking highly of your facility can lead to servicing their relatives, friends or co-workers.
Patient satisfaction surveys are a great way to receive feedback from the community. Building a strong online presence with a website dedicated to your facility can help increase virtual foot traffic. Include pertinent information such as services offered, provider headshots along with a biography. Also, provide a user-friendly patient portal, to grant the patient access to their records or pay bills online.
Adding virtual hours after normal operating times for individuals that work will reduce the number of “No Shows” during office hours, which in turn reduces loss revenue. Partnering with local schools to offer sports physicals, mental health assessments and child health fairs as well as offering job shadowing, medical and healthcare scholarships show support for all age groups along with all educational backgrounds.
Although it can be difficult to implement these additional steps, they can increase revenue drastically. Are you doing everything you can to be sure no money is left on the table? Do you need assistance with implementing these changes? Contact JTS Health Partners to ensure all steps have been taken to increase your facility’s revenue.
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