Tips on Introducing Value-Based Quality Care to the Day-to-Day Operations of Your Organization

As healthcare continues to embrace value-based care, it’s increasingly important for organization leaders to be on-trend.

Those who can quickly implement this way of thinking and operating will see an increase in patient engagement as a result of higher quality care. Those who struggle to embrace value-based care will fall behind as consumers turn to other, more attentive providers who can offer better results.

Here are three tips to help your organization succeed in its transition to providing value-based care as opposed to fee-for-service treatment.

1. Streamline front-end operations and payment processes

One of the biggest areas for opportunity with a value-based care model is front-of-house operations. Patients don’t like having to wait for their provider if they show up on time for their appointment. When being admitted into a hospital or skilled nursing facility, it’s not ideal to fill out piles of paperwork, either.

This means you must streamline your front-end operations, no matter the kind of organization you run. Make it easier for patients to provide their eligibility information, and help your staff verify eligibility by investing in the right software.

Advanced verification and claims management tools like ABILITY COMPLETE® can significantly speed up the entire billing process. They’ll provide your team with all the information they need to share with patients. To embrace value-based care even more, ask your team to clearly explain patient eligibility.

Patients who have a better understanding of their coverage and payment responsibilities will show higher levels of engagement. They’re also more likely to pay what they owe on time, especially if you have credit card processing capabilities on site. Other payment processes patients respond well to are online bill pay and automated payments.

2. Focus on comprehensive care and wellness

In addition to front-of-house improvements, you also need to change how you deliver patient care. A diagnosis and prescription won’t cut it anymore. Patients want a much deeper understanding of their health. They want a comprehensive approach to treatment – something that teaches them healthy behaviors they can continue after their treatment is over.

The desire for these long-term solutions is the result of the challenges today’s healthcare consumers face. It’s much harder for them to access care, and the cost of care is a big concern for patients as well. In fact, a recent study states 40% of Americans skipped a recommended medical test or treatment in the last 12 months due to cost.

Additionally, Americans fear the cost of treatment more than the potential illness. When they do seek care, they’re looking for the best, most well-rounded and effective treatment they can find in order to prevent future healthcare costs.

3. Boost revenue with CMS value-based initiatives

If patients avoid healthcare and only engage in comprehensive treatment, what does that mean for providers? CMS is aware that providers may be concerned about losing revenue, so they’re rolling out value-based initiatives to ensure both providers and patients benefit from this transition.

If providers can prove that they’re creating comprehensive health plans and focusing on the long-term well-being of their patients, they’ll receive payment. The qualifications and terms of each CMS plan is unique, but the opportunity is there (or on its way) for providers to increase the level of patient care they provide without hurting their revenue.

The shift toward offering higher-quality care in a more accessible manner has already begun. If your organization has yet to make the necessary adjustments to embrace value-based care, now is the time.

Why We Need Data: Understanding How Healthcare IT Improves the Patient, Provider and Payer Experience

Manual processes increase the risk that a healthcare organization wastes time, makes mistakes and misses out on potential earnings. They can hinder the patient experience and put a strain on relationships with payers.

These are just a few reasons why some healthcare leaders invest in the support of technology. However, of those who use advanced systems and applications, not all are taking advantage of the predictive analytics and insights available.

The key purpose of automated work is to produce faster, better results. This occurs when advanced functions are introduced to an organization’s workflows, but it doesn’t stop there. By learning from the specific metrics and performance reports available in advanced applications, providers can further enhance the treatment experience for themselves, their patients and even for payers.

Here’s a closer look at what happens when healthcare leaders make their workflows data-driven.

Patient satisfaction increases

Delivering a high level of patient satisfaction requires more than medical care. The patient experience begins from the moment an individual schedules their appointment or is admitted. It continues as they interact with admissions, caretakers and billers throughout treatment.

Patient satisfaction may increase or decrease during this time for a variety of reasons. Analyzing data from previous patient interactions positions providers to produce higher levels of satisfaction.

If you were to have your team track care quality levels, infection outbreaks and slips and falls, you’d have a better understanding of the opportunities to increase patient satisfaction – as well as safety and treatment success. You could start working proactively to reduce the likelihood of negative experiences and focus your efforts on going above and beyond to exceed expectations.

Providers’ operational efficiency skyrockets

The use of advanced analytics helps you do more for patients as well as your staff. Imagine if your billers could create and send claims in half the time it takes them now. Or if you could better engage and communicate with your entire team.

With the right tools, you can access the data necessary to improve these things, too. Detailed revenue cycle performance reports can identify the most common mistakes your billers make.

Additionally, data on staff attendance can help you cut overtime costs and avoid burnout. Your scheduling program may even have credential tracking capabilities to help your entire staff stay up to date with required education.

Payers enjoy higher quality scores and better member retention

As patients become more engaged in their treatments and providers deliver higher-quality care, payers’ performance improves. Their quality scores go up thanks to the providers who deliver satisfactory data-driven results. Over time, this results in better member retention for payers and patient retention for providers.

Technology and healthcare are continuously becoming more intertwined. They will continue to enhance the patient experience throughout treatment, but only as providers and payers embrace the advanced tools and analytics available to them. This trend goes hand in hand with the rising importance of value-based care.

What is your organization doing to stay ahead of the curve?

revenue cycle management strategy

Why More Utilization of Data Can Lead to Fewer Denied Claims

Denied claims negatively impact your financial performance, put more stress on your billers and hinder the patient experience. However, most denied claims can be prevented!

There’s no reason to let lost earnings continue to slip through the cracks, or to keep settling for delayed payments. With the right tools, you can immediately start improving your revenue cycle management process.

Not sure what your RCM process is missing? Keep reading to discover how using advanced analytics can increase your claims acceptance rates.

Monitor at-risk revenue

Revenue is at-risk of being lost when you have claims that are approaching the 12-month filing limit and when new claims have inaccurate or incomplete patient/payer information.

It’s hard to catch these things when working manually, but an advanced reporting tool can notify you of all the errors you need to fix. It generates the information you need to better prioritize payer responses and provides the visibility to monitor all at-risk revenue. This results in a major workflow shift from constantly playing catch up and fixing errors, to preventing mistakes in the first place, causing fewer denied claims.

Better understand workflow trends and needs

It’s necessary to monitor and work on previously denied claims in the same way it is to submit new claims. More importantly, there’s valuable data to gather from denied claims.

Pull performance reports on all your denials. The data provided should shed light on recurring billing errors and opportunities to better capture revenue. It will help you make sense of why claims aren’t getting accepted and identify workflow issues that need immediate attention. These insights have the potential to improve your clean claims rate, shorten A/R days and boost your bottom line.

Streamline and simplify performance reports

Performance reports are highly beneficial if used properly. Your team needs to focus their time on taking advantage of the key insights within reports, rather than gathering data and creating reports. They need an advanced reporting tool like ABILITY® EASE All-Payer.

When you simplify the creation of reports, you can dig deeper into what the data is telling you. This allows you to quickly start improving your denial rates, rather than wasting time on report generation.

If you’re constantly catching mistakes after a claim has already been denied – or you’re curious why you’ve lost a certain amount of revenue – start reading between the lines. Utilize the data available to you. Apply it to your workflow, share the insights with your team and strive to keep learning. Over time, your acceptance rates will reflect these efforts.

eligibility verification

3 Ways to Make Your Eligibility Verification Process More Efficient

Eligibility verification is the first step in the revenue cycle – and arguably, the most important. Without an efficient verification process, it’s hard to communicate with payers and determine payer/patient payment responsibilities. These challenges can increase the number of mistakes made during claims submissions. They may also add time to your average A/R days or lower the revenue you’re able to capture each month.

If you’re familiar with the costs of patient eligibility challenges, try a different verification approach. Here are three ways you can increase eligibility verification efficiency.

1. Take advantage of real-time eligibility verification opportunities

Verifying patient eligibility via individual payer portals or over the phone is not ideal. These processes are extremely time-consuming. They delay patient access to treatment and often cause stress for front-of-house staff.

A real-time verification process, available through a single eligibility portal, is much more efficient. It simplifies communication with payers and provides quick eligibility answers, meaning your team can verify coverage in a matter of seconds, not hours or days.

With the right tool, you can enjoy this fast, highly efficient workflow to communicate with Medicare, Medicaid and private payers.

2. Save time with saved patient data  

Real-time verification is just one of the many workflow benefits that an eligibility portal like ABILITY COMPLETE® can provide. Additional functions may include storage of eligibility transaction history and the ability to resend prior eligibility requests.

Having access to this data offers significant time-saving opportunities. It gives your team all the information they need to quickly verify patient eligibility every single time a patient comes in. This replaces the slow, tedious task of asking patients to fill out forms and having staff manually input their information. It results in increased patient satisfaction and decreases the likelihood of sending claims with inaccurate information.

3. Educate patients and collect payments before treatment

To achieve a high level of efficiency throughout the revenue cycle, engage patients early on. Educate them about their coverage and their payment responsibilities. Break down the costs of treatment for both long-term and one-time services, and collect each payment at the time of service.

Providing patients with an understanding of their payment responsibilities up front helps your business avoid possible loss of payments. It reduces the risk of inadequate benefit challenges after treatment has started, and it increases the likelihood that a patient completes their long-term care plan.

Innovative processes combined with attentive patient care can transform your RCM performance. In terms of eligibility verification alone, the best way to improve efficiency is to focus on working faster while producing more accurate results.

revenue cycle management

How to Reduce A/R Days and Increase Revenue Cycle Management Efficiency

It doesn’t matter how many patients walk through your doors if you’re only receiving a small percentage of payments. You can work hard and provide exceptional care, but as far as your bottom line is concerned, the most important thing to focus on is revenue cycle management efficiency.

What is the average number of A/R days it takes for you to complete a payment cycle? How strong are your claim acceptance rates?

These are just a few of the performance indicators to consider when assessing RCM efficiency. If you’re struggling to receive payments, use the following five tips to bring your A/R days up to speed with the industry average – or even better!

1. Verify eligibility before each visit

It may sound simple enough to verify eligibility before rendering services, yet many billers find themselves jumping through eligibility hurdles after a patient has seen their caretaker.

This may happen because a patient’s coverage has changed from one visit to the next. It could be due to changes in their condition that affect eligibility, or that they didn’t provide all the information necessary for a biller to verify them.

It’s much better to gather all patient information and verify eligibility upfront than to scramble to make a claim post-service. If your current workflow doesn’t stress this, communicate the value of confirming benefits and acquiring appropriate prior authorizations with your front-of-house team immediately.

2. Utilize an automated, rules-based workflow

Think of all the different payers you work with and the many claims you send to them. Consider all the conditions you treat and the unique codes you have to use for each one.

Even your best billers are bound to make mistakes from time to time. They may send a claim to the wrong payer or input the wrong code on a claim to the right payer, resulting in denials and rejections.

The better way for them to work is to utilize an RCM platform with rules-based workflow capability. When you set specific rules, your billers will be notified if they’re about to make a mistake. Your new, advanced system can tell them if information is missing or incorrect. It can advise billers to make necessary corrections before they send out a claim, saving you a significant amount of time in the revenue cycle.

3. Streamline different revenue cycle management processes

It only takes one thing to go wrong for your entire revenue cycle to be affected. And between verifying eligibility, managing claims and processing payments, there are plenty of opportunities for mistakes to occur. Fortunately, you can prevent and correct mistakes by streamlining your RCM processes with a tool like ABILITY EASE® All-Payer.

Stop thinking of eligibility, claims management and payment processing as separate activities. Instead, consolidate these pieces of the revenue cycle into one simple, easy to manage workflow. Invest in one tech-savvy system to help you handle claims from start to finish, instead of having a separate system for eligibility verification, claims and payments.

This will save a significant amount of time, money and stress. It will allow billers to easily move from one step of the revenue cycle to the other. It will lower the risk of mistakes and increase claims acceptance rates.

Before you know it, your average A/R days will be much shorter. Plus, your staff will perform better, become more engaged and have higher overall satisfaction.

4. Diversify patient payment options

With the rise of patient payment responsibility comes a bigger need for providers to diversify their payment options.

Put yourself in the position of a consumer for a moment. Consider how often you swipe a credit/debit card, use a payment application or rely on automated payments to transfer funds. Most people use such tools when paying for everything from a snack at the corner store to their car payment. They expect to have similar payment options when they’re billed for medical services.

This change comes at a low cost when the long-term benefits are factored in. Although it may be a big investment upfront to start offering modern payment options, the positive response from patients will provide the ROI you’re looking for. They are more likely to pay on time and you’ll be able to process payments much easier, too.

5. Resubmit all denied claims

The final way to increase your RCM efficiency is to make sure no claim goes unpaid. The tips mentioned above should significantly reduce the amount of denied claims your team has to resubmit. But, whenever a claim is denied, it needs to be adjusted and sent back to the appropriate payer.

You may prioritize new claims over denied claims. However, every single unpaid dollar adds up – it can contribute to the amount of money you have outstanding, or it can be revenue you collect and utilize.

Luckily, a streamlined workflow can make it much easier to manage denied claims. Combined with a better eligibility verification process, rules-based functions and diversified payment options, your RCM efficiency will be better than ever.

infection prevention

4 Infection Prevention and Control Tips to Use in Your Organization

There’s more to maintaining the health of your patients than treating them for their existing conditions. Providing a high level of quality care also means keeping them safe from additional health risks.

Health risks may include everything from a slip and fall to a flu outbreak to more serious matters like strep throat, UTIs and gastrointestinal infections.

If these or any other infection has recently affected your organization, it’s time to re-assess your infection prevention and control strategy. If no infections have occurred thus far, it’s best to keep building on the infection prevention practices you’re currently using.

The four tips listed below can help you lay the foundation for an infection-fighting strategy or improve the one you already have.

1.    Create a dedicated quality care and infection prevention team

Fighting harmful bacteria is the responsibility of all staff, so it makes sense to put employees from various departments in charge of infection prevention. A dedicated team can help ensure there are no gaps in your plan to prevent outbreaks. The combined knowledge and experience of each person will provide you with all the information you need to:

  • identify high-risk areas where an infection may occur
  • improve antibiotic treatment protocols
  • limit the transmission of antibiotic-resistant bacteria
  • expand infection surveillance capabilities

Additionally, a dedicated team can facilitate stronger communication and collaboration as staff works to keep infections at bay – and to control them in the event of an outbreak.

2.    Close the gaps across all department functions

Beyond your dedicated team, all staff members should be actively working to avoid an outbreak. Every employee needs to understand the critical importance of infection prevention and be committed to their role in it.

This begins with sharing the right information. Educate your whole team – not just those who work directly with patients – about infection control. Make sure food service individuals understand the best practices to use when preparing and distributing meals. Talk to housekeeping about the personal protective equipment they should use while they work. Explain infection prevention and control to your administrative staff, too.

Also remember to correct bad habits, even for seemingly simple prevention efforts like hand-washing and the use of gloves. These are two of the most commonly overlooked aspects of infection control, but they make a big difference.

3.    Streamline infection surveillance

Just as you must close the gaps between each team’s role in infection prevention, you need to also streamline surveillance. This is hard to do with incomplete documentation of outbreaks or a lack of adherence to evidence-based guidelines. However, having all the infection information you need in one place can do wonders for how well you prevent and control outbreaks.

Imagine if you could access infection records at the click of a few buttons instead of spending hours sifting through paper files. Or, if you had the option to track infections on a map or evaluate infection data in terms of category, type and culture organism. You’d have a much deeper understanding of the infections your organization commonly deals with, and you’d be in a better position to prevent future outbreaks.

You don’t need more time in the day or even extra staff to do this. You just need the right tools to help you keep your patients safe.

4.    Act fast and track everything

The faster you can identify an infection, the less risk it will present to your patients and staff. Streamlining surveillance will help you notice an outbreak, but you need to have an action plan in place. This is key to controlling an outbreak. A clearly-communicated, effective action plan can be the difference between a small, manageable outbreak and one that affects many patients.

But, the plan you have in place today doesn’t necessarily have to be the one you use tomorrow. Whenever an outbreak happens, gather all the data you can. Record patient interventions and identify clear categories to make sense of the data. Make graphs to reflect employee performance and create a full overview of how effective all infection control and treatment efforts were.

If you’re not currently dealing with an outbreak, you should be continuing the work to keep infections at bay. If an outbreak recently affected your organization, it’s worth trying a new approach to how you prevent and control the spread of harmful bacteria. Fortunately, the tips above can guide you in improving your organization’s performance when managing infections.

workforce management tips

Reducing Overtime Pay and Understaffed Shifts – A Closer Look at How to Better Manage Your Team

Working overtime hurts employee morale. It causes staff burnout and hinders the patient experience, which can also occur when a shift is understaffed. There’s often a correlation between these two scheduling issues, leaving many healthcare leaders wondering what they can do to increase their workforce management efficiency.

The answer is simple: stop the cycle of overtime and burnout!

Not sure how to do that?

Here are a few tips on how to simplify this complex process for the benefit of all. But first, a closer look at the cost of scheduling inefficiencies.

The Real Cost of Scheduling Overtime

Scheduling issues – like working overtime, paying for overtime and struggling to keep up with the workload of an understaffed shift – only lead to more serious problems. These may include:

  • Low levels of employee engagement
  • Low patient satisfaction scores
  • High rates of employee turnover
  • Patient safety concerns
  • Inefficient allocation of company finances
  • Confusion and miscommunication across teams and departments
  • Mistakes in patient medication and treatment
  • Additional mistakes in other workflows

There are also more specific costs to consider.

For example, if your best nurses are overworked, the training of new nurses can suffer. If your facility is frequently understaffed, performance ratings will reflect that, making it much harder to recruit new patients and/or team members.

Fortunately, there are many ways to avoid these problems.

How to Improve Workforce Management Efficiency

To transform your scheduling workflow, you need to automate the process, establish specific scheduling rules and communicate better.

1. Automate your scheduling process

If you’re not already using an automated tool to schedule shifts, invest in one right away. An application like ABILITY SMARTFORCE® Scheduler can completely change how you identify the needs of each shift and track staff hours.

It can ensure you don’t miscalculate hours or overlook a shift that needs to be filled. It will also help you monitor performance indicators like on-time attendance, sick calls and no-shows. Together, these capabilities can give you a full understanding of how well your scheduling efforts are performing.

2. Establish job-specific rules across your organization

In addition to the automated staffing functions mentioned above, you should also take advantage of setting job-specific rules if this is available. This function will help you differentiate between salary and hourly employees. It can give you a more accurate picture of how each shift adds up on payroll, while further preventing schedule mistakes from occurring.

You might even use this as a resource when identifying hiring needs. The historical data of certain roles/departments can shed light on where extra talent may be beneficial.

3. Communicate expectations and set staffing alerts

When implementing any kind of scheduling change, you need to make sure your staff is on board. The best way to do this is by communicating clearly. Tell them that you’ve heard their concerns and share your plan for improving scheduling efficiency.

Your plan should include clear expectations for how the whole team will move forward. You might choose to address specific problems like call-outs and no-shows with a more rigid disciplinary protocol. Or, you could create a new process for trading shifts and updating availability.

To track how well these rules are adhered to, set staffing alerts. These will tell you when a shift becomes understaffed as individuals drop them or don’t show up.

Having a satisfied, motivated team is critical when running a high-performing organization. And since healthcare employees typically operate at an above average risk of burnout, the pressure is high for employers to master staffing efficiency and employee engagement. Don’t put this off any longer. Improve your scheduling process today to enhance staff performance and satisfaction.

workforce management

Adjusting to Tech-savvy Millennials in the Healthcare Workforce

Millennials are now the largest population of working Americans. This generation makes up 34% of the nation’s workforce, and many millennials are either already part of a healthcare organization or have plans to enter this industry. However, not all industry leaders understand the effects this has on workforce management.

Many long-time medical professionals are out of touch with the strengths, desires and habits of millennials. These leaders are slow to adjust to technology-based processes and new ways of thinking, which can significantly impact their organizations in a negative way.

Is your team already experiencing workforce-related issues, specifically with millennials? Are you interested in taking a proactive approach to better reach and retain millennial employees?

Here are three ways to prepare your organization for the growing millennial employee population within healthcare.

1. Improve outdated processes

Millennials have grown up with the internet. They’re used to working with automated systems and intuitive programs for both professional and personal functions. They work fast and smart, often using technology to support their work.

If your organization is still sending out claims by standard mail or printing staff schedules on paper, you’re not operating with millennials in mind. This population wants to be part of a team that encourages innovative thinking. They respond best to workforce management processes that save time and improve efficiency, which are only present in organizations that utilize advanced tools.

Consider the processes you currently have in place and ask yourself where they can be improved. You may choose to upgrade how you enroll new patients, bill claims, track staff credentials or capture market share. There’s no limit to the progress your organization can make when you combine the right technology with a staff who knows how to use it.

2. Implement advanced communication channels

Not all improvements have to occur at a high level. Simply changing how your team communicates can make a big difference in millennial engagement. It is this generation’s nature to be hyper-connected, but only when the information they need is easily accessible.

Start using an advanced staff scheduling program like ABILITY SMARTFORCE® instead of a paper-based system. Take advantage of a phone application that allows team members to trade shifts, change availability and request time off. Give them the chance to interact within the app for fun purposes, too. This may include functions that allow employees to share shout-outs or remember important dates like birthdays and work anniversaries.

Millennials won’t be the only ones who respond well to such workforce management improvements. Others on your team are likely to be equally invested in the new communication channels available.

3. Play to the unique characteristics of this generation

The misconception of millennial characteristics is one of the main reasons why professionals across all fields hesitate to adjust to the needs of millennials. Millennials are often thought of as entitled or impatient. Their lack of interest in certain processes may come off as lazy. But, these behaviors often stem from a desire to work in a more efficient manner – and in their mind, technology plays a key part in that.

It could be true that your new hire, age 20-25, is entitled or disengaged. Or, he/she could simply be inquisitive and performance-driven. They may be challenging upper management and the status quo because they’re interested in establishing better workflows. This person might be familiar with technology you haven’t tried yet. They may see the potential to lower mistakes, improve processes and/or boost engagement by leveraging new technology.

Give your millennial workforce the opportunity to present their ideas. Allow them to act on some of the initiatives they present. You’ll likely be satisfied with the results. Beyond better engagement, new tools or processes can potentially save money, improve the patient experience and much more.

Keep in mind these results depend on your willingness and ability to adapt to the tech-savvy millennials on your team. Make it a point to include all employees in the conversation as your organization progresses.

patient education

How to Better Educate Patients About Their Coverage Rights and Payment Responsibilities

Many healthcare consumers experience confusion and stress regarding their insurance coverage and payment responsibilities. They often have questions about when payments are due, how much they’re expected to pay and why their insurance doesn’t cover a certain treatment.

This can deter patients from seeking treatment at all. It can also cause patients to stop treatment before their condition has been resolved, and those who do continue treatment will become disengaged if their confusion and stress aren’t addressed.

Fortunately, all of this can be prevented with better patient education. If you’ve recently had a patient stop treatment due to payment issues or lack of engagement, consider how well you’re explaining treatments – and the associated eligibility requirements and payment responsibilities.

To keep patients informed at the start of and during treatment, use the tips shared below.

Effective patient education methods

Patient education is an ongoing process and a team effort. From front of house staff who schedule appointments and handle patient payments to those who provide patient care, all employees should be dedicated to offering the best patient education possible.

To help your staff do this, consider implementing some of the following patient education strategies:

  • Offer transparent pricing
  • Create flexible payment plans
  • Disclose if a treatment may not be covered by insurance

Additionally, stress the importance of correcting any misinformation a patient may have about their treatment. If their insurance doesn’t cover a procedure that is deemed necessary by their physician, explain the disconnect as well as you can, and discuss other payment options or procedure alternatives.

The connection between patient education and engagement

Patient education and engagement tend to have a direct relationship. When a patient feels well-informed about their eligibility and payment responsibilities, they typically take more ownership in the process and stay up to date with payments.

But when a patient feels like they haven’t been given the proper information, the opposite occurs. They may pay their medical bills, but they may pay late or not in full.

More importantly, the patient experience suffers. While they try to sort out coverages and out-of-pocket expenses, their treatment can be delayed. Their condition could change or worsen, requiring a new treatment plan, and in turn, a change in eligibility, coverage or payments required. If the burden becomes too great, they may find another provider or stop treatment altogether.

claims management

Clean It Up: 3 Tips to Transform Your Claims Efficiency

All healthcare providers want clean claims, but not all billing teams have the right tools and practices to operate efficiently. They may be working manually, taking too long to complete prior authorizations or struggling to keep up with denied claims – all of which can significantly delay the revenue cycle.

If your organization is experiencing any of these billing inefficiencies, it’s time to improve your claims management process. Here are three strategies that will help you and your team work faster and smarter.

1. Streamline eligibility checks

Manual workflows don’t allow for the best utilization of time and talent. Tasks take longer to complete, and the work has a higher chance of error. Automating eligibility verifications can give your team a significant amount of time back in the day. It enables faster claims creation and submission, lowers employee stress and increases patient satisfaction.

Streamlining this process also allows providers to determine eligibility for multiple patients at one time, or one patient’s status with multiple payers. Logging into multiple screens to locate co-pays, termination dates, deductibles and coinsurance information becomes a thing of the past. These electronic systems also store and organize data, making it easy for billers to manage patient eligibility and claims.

2. Improve your denials management process

Denials management can be broken down into two parts: resubmitting denied claims and preventing future denials. Adjusting denied claims should have the same priority as creating new claims, and all claims should be validated before they’re sent and tracked after to ensure they are paid. Validation minimizes the risk of making minor, yet common, mistakes such as:

  • Sending claims with incomplete or inaccurate patient information
  • Sending claims to the wrong payer
  • Submitting duplicate claims

Being more proactive against these issues speeds up your RCM, and sets the tone for ongoing claims efficiency.

3. Simplify patient payments

As patient payment responsibility continues to increase, the need for providers to simplify the payment process will rise as well.

Cash and checks won’t cut it anymore. Patients want to be able to swipe their credit/debit card in your office and submit payments online at their own convenience. Some will prefer payment plans with regular small payments to larger, one-time expenses. Patients may also respond well to automated payment options.

Providing various payment options, combined with automated prior authorizations and improved denials management, ensures claims efficiency across the board. Whether you’re sending a claim to insurance companies, Medicare or directly to patients, each payment process should be simple, stress-free and beneficial for all.