By Shanna DeLeo, Senior Vice President of Development for Sunrise™, Altera Digital Health
According to a survey by the American College of Healthcare Executives (ACHE), financial issues remain a top concern for healthcare CEOs, second only to staffing shortages. Of these CEOs, more than half say that revenue cycle management (RCM) and converting charges to cash are among their biggest challenges.
As operating costs increase and reimbursement decreases, organizations must uncover more opportunities to widen their margins and continue supporting high-quality care. If you’re struggling to maintain financial stability, determine if your organization is making any of these costly—yet fixable—missteps:
1. You’re billing the wrong patient.
Most hospitals and health systems use a variety of IT solutions to meet the unique needs of each department. This creates unintended consequences when electronic health records (EHRs) and other systems don’t cooperate, and patient misidentification is a big one. In fact, it can cost healthcare organizations up to $17.4 million annually. Patient identity issues slow down cashflow as denials are incurred and claims are then corrected. Organizations seeking to minimize patient identification errors can leverage an enterprise master person index to assign a unique identifier to each patient that acts as a “glue” between disparate systems. At Altera Digital Health, we’ve also built patient duplication alerts into the Sunrise platform to ensure the correct patient is billed the first time, every time.
2. You’re failing to complete medical necessity checks.
To comply with Medicare and receive payment, organizations must complete medical necessity checks on all outpatient procedures. If a procedure won’t be covered by Medicare, then you need to secure an advanced beneficiary notification signed by the patient before any services are rendered. Otherwise, your organization will be held responsible for all costs incurred for that procedure. Implementing a solution that not only prompts users to run medical necessity checks, but also updates on a regular basis can help your organization remain compliant with changes from local or federal governing bodies.
3. You don’t have standardized coding.
When it comes to charge capture, many organizations have developed a “homegrown” approach to the way they code. If the coding methodology is too subjective, two different staff members may code the exact same procedure differently. This can be especially problematic in outpatient settings like the emergency department as patients may receive multiple injections or infusions, which tend to be more complicated to code. Discrepancies in coding can then lead to missed charges or denials from payers. If your coders are not aligned, consider a solution like Sunrise that automates the assignment of coding hierarchy for the entire patient visit based on CMS and CPT guidelines.
4. You aren’t prioritizing usability.
It is well established that traditional EHRs are a major source of frustration and burnout for providers, in part because data they need to make decisions is not always readily accessible. Similarly, non-clinical teams are spending too much time and attention on navigating technology to perform their job duties. Your billing office needs episode management tools that bring relevant information to the forefront so short-staffed teams can submit clean claims without clicking through multiple areas of the product. Additionally, work queues can prioritize tasks for staff members based on how much value they bring to the organization, taking out the guesswork and increasing the speed of cashflow. Altera understands that smoother, quicker user experiences can bring greater returns across the enterprise. This is why we develop solutions that not only work the way your staff members want them to, but also how your organization needs them to.
You can do things differently.
The revenue cycle has many repeatable, process-driven elements, but it is still full of complexities that can chip away at your bottom line. Your organization deserves to be paid fully for the care administered—and your teams deserve the tools to make that happen.
Looking for a change? Learn more about Sunrise, the alternative you need for the outcomes you want, here.