Here are five revenue cycle management tips from experts, published by Becker's Hospital Review after July 11.
1. Tara Dwyer, vice president of audit operations at Xsolis, recommended hospitals prioritize claim denial appeals based on the clinical merit of individual cases. "New technology and algorithms now provide insight into which cases are most likely to be overturned, giving denial management teams the starting point they need to engage with each case," she told Becker's Hospital Review. "By prioritizing, your team will be able to recover revenue sooner. Additionally, by looking at trends in this data, you can spot commonalities and opportunities for improvement throughout the revenue cycle."
2. Monte Sandler, executive vice president of revenue cycle management at DocuTAP, recommended healthcare providers follow appropriate billing guidelines for each contract with third-party payers. "With the various types of contracts urgent care providers are entering into with third- party insurers, it's extremely important to follow the appropriate billing guidelines for each. For example, clinical guidelines are not necessarily the same as those for billing," he told Becker's Hospital Review. "Many contracts require all providers to be individually credentialed, and services to be billed under the rendering provider, whereas some contracts allow all providers to bill for services under the group national provider identifier."
3. Lyman Sornberger, vice president of client development at Charles J. Hilton and Associates law firm, recommended healthcare providers use a third-party law firm in disputes with payers. "Healthcare providers should strive to effectively use law firms for disputes on underpaid or unpaid insurance claims," he told Becker's Hospital Review. "Many health plans nationwide do not always follow proper claims procedures when making decisions to reimburse or deny a medical service."
4. Rebecca Haymaker, director of Epic services at Parallon Technology Solutions, recommended hospitals educate patients and staff to achieve a successful point-of-service collections program. It is crucial that frontline employees clearly understand expectations for collections; that staff are trained on processing balances and payments; and that employees know how to effectively seek payments and handle objections, she told Becker's Hospital Review.
5. Jason Considine, senior vice president of patient access, collections and engagement for Experian Health, recommended hospitals closely examine online reviews from patients to gain insights to improve customer satisfaction and boost payments. "Research shows that higher online ratings correlate with previously established metrics for evaluating hospitals, such as lower potentially preventable readmission rates. When it comes to overall satisfaction, healthcare customers are extremely perceptive, and they're unafraid to share their opinions — good and bad," he told Becker's Hospital Review. He said it is up to hospitals to identify areas of improvement by looking at patient feedback.
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