revenue cycle management

How to Decrease Your Rate of Rejected Claims

Imagine if you went into a patient visit knowing that you wouldn’t receive payment for your work. Would you invest as much time on that patient? Would you hope to see their name on your schedule again?

Compare this scenario with one in which you know for a fact that you’ll receive payment. Most healthcare professionals would choose the latter. However, many hospitals and facilities receive payment rejections on a regular basis. As much as you want to provide every single patient with the best possible treatment, you also need to make sure you’re collecting all the projected revenue associated with your work.

If you’ve been seeing a spike in rejected payments, it’s time to reassess your revenue cycle management efforts. Try using these five tips to help prevent rejected payments.

1. Clean up your documentation and coding process

In a recent HIMSS Media survey, 41 percent of respondents said clinical documentation and coding is a high-risk area for losing revenue, and 43 percent of respondents considered it a medium-risk area.

If you agree, put a stronger emphasis on correct coding. Invest in employee training to ensure that everyone understands the codes your team is working with. Or, try scheduling more people per shift so your team isn’t spread thin and is less likely to make mistakes.

These are just a few ways to improve coding efficiency. If coding errors are affecting your organization, you can’t afford to overlook this issue any longer.

2. Send claims in batches rather than one by one

Sometimes, payment rejections occur because a claim has been submitted to the wrong payer. Additional reasons for rejections include:

  • Inaccurate or missing patient information
  • Inaccurate payer information
  • Terminated coverage
  • Timely filing deadlines
  • No referral on file (for applicable services)

Batches can’t solve all these issues, but they can offset the chances of payment rejections. Working in batches means you can group claims by payer. It reduces the risk of sending claims to the wrong payer and helps you file claims in a timely manner.

Thanks to the digital systems that make working in batches possible, you’re also able to prevent inaccurate or missing patient information as you work through each claim in your batch. Think of your eligibility and claims management system as your second set of eyes. It will tell you if there’s any adjustments you need to make in any claim within a batch. When you have no notifications, you can trust that every claim has all the information it needs to be accepted.

3. Consolidate your claims management

Speaking of eligibility and claims management systems, how many different revenue cycle management tools do you use? Do you have one filing process for Medicare and Medicaid payers, plus a separate way of submitting claims to private payers?

This kind of workflow only increases your risk of rejected payments. On the other hand, using a single portal like ABILITY EASE® All-Payer to communicate with payers makes your RCM more efficient. It increases the accuracy of each claim you make, and helps you catch any mistakes before a claim is submitted.

The result? A faster, cleaner claims management workflow.

4. Track your audits and appeals

Although automated tools can significantly increase claims efficiency, they can’t guarantee first-time acceptances for every single claim. Make sure to track your audits and appeals whenever you find yourself resubmitting claims.

This provides full visibility on all your outstanding payments. It allows you to track financial performance metrics and hold your team accountable to the goals you’ve established. It can also help you adjust your financial strategy if necessary.

5. Save patient data

The final tip to help you decrease rejected payments is to save patient data. This will significantly improve the accuracy of every claim you create, in addition to speeding up eligibility verifications and claims submissions.

Note, this doesn’t mean you should keep storing paper files for all your patients. The better option is to save patient data within your claims management portal. This way, all you have to do to create a new claim is click a few buttons. You can quickly pull the information you need and trust it’s accurate, rather than waste time sifting through piles of paperwork and double-checking everything manually.

There’s no reason to keep letting rejected payments add up, or to spend hours on revenue cycle management. Start using tips above to improve your chances of receiving full payment with a faster, more accurate workflow.

patient satisfaction

The Impact of Patient Satisfaction on Your Revenue Cycle

The value you offer patients has a direct effect on the revenue you collect. This applies to all healthcare organizations, but unfortunately, not all providers understand the impact patient satisfaction can have. The more satisfied your patients are, the better your revenue cycle management performance will be, which affects many other aspects of your business.

Here’s a closer look at how patient satisfaction contributes to financial growth (and losses).

The high costs of low patient satisfaction

Patients want clear pricing and payment expectations. They also want:

  • A deep understanding of their condition
  • Actionable steps they can take to improve their health
  • Simple, stress-free payment processes
  • The option to manage high treatment costs with a payment plan

All these things show patients that they’re genuinely cared for. When providers offer such resources and payment options, patient satisfaction increases. When these aren’t included in treatment, patients are likely to be dissatisfied.

And when satisfaction is low, many aspects of your organization are hindered – including financial performance, market share, and care quality. Dissatisfied patients are less likely to pay their medical bills in full, if at all. There’s very little chance these people return for more services, which is how market share can suffer. Even patients who continue treatment may not be fully engaged, resulting in a decrease in quality care levels as patients stop adhering to their treatment plans.

Luckily, these issues can be avoided by investing more in your patients. There are plenty of ways to increase patient satisfaction while also improving revenue cycle management performance, care quality and much more.

The revenue cycle management benefits of investing more in patients

Providing a more satisfactory patient experience can be as simple as taking the time to explain payment responsibilities or as significant as implementing new tools and processes. Convenient payment technology or an advanced claims management system can help you better serve your patients, your staff and your bottom line.

The following is a closer look at three of the top ways to increase patient satisfaction with improvements to revenue cycle management.

1.     Help patients pay faster – and in full

Price and payments are some of the biggest factors that affect patient satisfaction. While you may not be able to lower your costs, you can make patient payments more accessible and easier to manage with a tool like ABILITY SECUREPAY™.

This allows patients to conveniently pay their fees anywhere, anytime. Patients with ongoing treatment can set up automatic payments and those who see you for one-time services have the choice to pay with a credit or debit card in addition to cash and checks.

These payment practices are very familiar to your patients; they’re tools patients use every day in other aspects of their lives. When patients have the option to pay for medical bills in the same manner, they’re more likely to pay quickly and in full, increasing patient satisfaction and practice revenue.

2.     Decrease billing mistakes

Billing mistakes don’t benefit anyone involved in treatment, yet for most organizations, they’re a common occurrence. These issues slow down your revenue cycle and can lead to lost profits. They’re also a stressor for patients.

If it’s become the norm to see your staff discussing billing mistakes with patients, it’s time to try a new approach. Implement an eligibility and claims management process that creates a satisfactory experience for all. Make it easy for billers to input patient information and track claims. Eliminate the need for your staff to sift through paperwork and the risk that patients’ bills go unpaid by their payers.

This will result in higher patient satisfaction and engagement, a more motivated staff and a healthier revenue cycle.

3.     Prepare for price shopping

One-third of healthcare consumers used the internet or mobile apps during the past year to compare the quality and cost of medical services. They price shopped before seeking treatment, a trend that will continue to rise in the coming years.

Providers need to prepare for this now by improving pricing transparency, strengthening their organization’s brand and increasing patient satisfaction. They need to put a bigger emphasis on value-based care and comprehensive treatment.

These are the details potential patients look for when comparing provider reviews. They keep current patients coming back and new patients coming in to begin treatment. Thinking long-term, an early adjustment to price shopping can mean significant rewards for your organization.

At the end of the day, all the functions of your organization should be rooted in one purpose: serving your patients. If you fail to meet their expectations, revenue performance will be one of the first things to feel the consequences. However, put the above tips to work to make sure your organization is performing well across the board and watch how patient satisfaction skyrockets – and how your entire organization benefits.

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.

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.

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.

denied low-value claims

The High Cost of Not Resubmitting Denied Low-value Claims

Most billers would rather work on fresh claims than to go back and forth with payers to settle denied or partially-paid claims – especially if the new claims are for high-value services. This makes it easy to ignore denied low-value claims as more new claims need to be created and sent out.

But, it doesn’t make sense to let low-value claims go unpaid! At the end of the day, you should be collecting for every single service rendered. If money is slipping through the cracks, it’s time to crack down on your claims management efficiency – and part of this means putting a stronger emphasis on resubmitting low-value denied claims.

Not sure this will make a difference for your organization? Here are the three biggest costs of not resubmitting denied low-value claims.

1. Less income

Every claim that goes unpaid is money you’ve worked for but haven’t received, and won’t receive until each claim is submitted and accepted. It may not seem like much to let $100 or $50 go here or there, but over time, these costs add up. They may result in thousands of unpaid dollars every year, a cycle that will repeat itself until all your claims are accounted for.

Simply by ensuring all denied and partially-paid claims are resubmitted and paid out, you increase your overall revenue.

2. Poor A/R performance

In addition to the financial burden caused by not resubmitting low-value claims, performance indicators take a hit. Collection rates dip as denial rates increase, and these trends will continue until you’ve taken care of your denied claims.

You can also work proactively to solve this problem. Once all denied claims are resubmitted, determine what’s causing so many denials. Make your claims submission process more efficient from the start so that you don’t have to worry about adjusting and resubmitting as many denied claims in the future.

3. Lower patient satisfaction

There’s already enough patient confusion regarding insurance coverage and patient responsibility – and denied unpaid claims only add to patient confusion. They increase frustration, put more responsibility on the patient and may even cause a delay in treatment depending on your organization’s payment policies.

There’s only so much a patient can do to ensure claims get paid. They can provide all the right information at the start of treatment and contact their insurance provider, but it’s your responsibility to manage the claim(s) associated with each patient.

To create a better experience for all, you can:

  • Ask staff to verify patient eligibility and coverage prior to treatment
  • Utilize historical patient data when creating new claims
  • Track claims after they’ve been submitted
  • Resubmit denied claims

Whether you currently have a high or low denial rate, the goal you should aspire to is 0%. Your first step in achieving this is to pay more attention to the denials you’ve been ignoring. Your team and your patients will thank you, and your organization will greatly benefit as a stronger bottom line opens doors to new opportunities.

advanced payment practices

More Money, Less Hassle: A Closer Look at the Value of Advanced Payment Practices

A high-performing billing office is one that rarely sees denied or rejected claims, makes few mistakes and has a thorough understanding of the payers they work with. It’s one that operates at top efficiency, providing the most possible value to the organization it’s part of.

If your billing office is slow to verify patient eligibility or has a high rate of denied or rejected claims, you’re not getting the most value out of this department. It may be time to introduce advanced payment practices – like the use of EHRs and the implementation of intuitive claims management software.

These can transform your billing performance. They position your team for success by giving them the tech-savvy tools they need to create better, faster results.

Here are the top five benefits of using advanced revenue cycle practices.

1. Enjoy faster claims submission and responses

EHRs allow billers to send claims to payers at the click of a few buttons. Compared to the time it takes to fill out a paper form, prepare it to mail and get a response, the benefit of submitting digital claims is clear. You can shorten your claims submission and response time from a few weeks to a few minutes. This significantly speeds up your revenue cycle, allowing you and your team to keep better track of claims and to see them reflected on the books faster.

2. Send claims in batches

Imagine if your billers were able to fill out and send multiple claims at once rather than managing claims one at a time. The batch claim capacity of some advanced payment tools allows them to do just that. This function gives billers the chance to cut their claims management time in half, if not more. It provides the ability to send a group of claims to each payer your organization works with, then adjust and resubmit individual claims as-needed.

3. Access patient history with ease

A few of the reasons why claims get denied may be:

  • There is missing patient information
  • The patient information provided is inaccurate
  • A claim has been sent to the wrong payer

Being able to generate patient history alleviates these problems. Once billers have all necessary patient information in a claims management system, they can easily retrieve it when creating a new claim without worrying if a patient’s name, address or insurance information is accurate. Billers may have to adjust the date to reflect the most recent visit/treatment or add additional services, but these steps are much easier to accomplish with access to patient history than when starting an entire claim from scratch.

4. Set unique rules

Defining unique rules within a claims management system offers two key benefits: it keeps your team up to date with the latest payer requirements and reminds them of your own facility-specific rules. By making payer rules readily available and/or utilizing if/then functions, you’re giving your billing department the resources they need to work smarter rather than harder.

Billers won’t have to hunt down payer information anymore. They’ll be more in tune with the specific needs of each organization you work with and have a deeper understanding of facility-specific expectations.

5. Reduce A/R days

This is where most organizations see the biggest value in using advanced revenue cycle practices. All the benefits listed above have one combined effect: they can largely reduce average A/R days.

Instead of waiting 60-90 days to see payments on the books, you may be waiting as little as 15-30 days. There’s no guarantee that every claim will be a clean claim or that payers will always provide a fast turnaround, but, when your billing department starts operating at top efficiency, it will put pressure on payers to quickly process claims and send payments. The A/R cycle should speed up and the overall financial performance of your organization will greatly improve.

Additional benefits of using advanced claims management practices include:

  • Fewer claims rejections
  • Fewer human errors throughout the revenue cycle
  • More time back in your team’s workday

Together, these benefits add an immense value to your organization. They create a healthier bottom line, a more engaged team and increase patient satisfaction. With advanced revenue cycle practices, everyone wins.

Billing mistakes

3 Billing Mistakes You Can’t Afford to Make Anymore

It’s hard to grow your business if it takes forever to process claims. The longer you wait for payments to come through, the more you have to put off investing in new initiatives like expanding your team, attending more conferences or moving to a new work space.

You need to address workflow issues and minimize mistakes if you really want to see a change in how quickly you can access payments.

Here are three billing mistakes to stop making right away.

1. Speeding through staff training

It’s hard to know which codes to put on a claim or which payer to send it to if you haven’t been properly trained. Unfortunately, this is the reality many medical billers are dealing with – especially if they’re in entry-level roles.

When billers aren’t shown how to navigate a medical office’s billing software, it’s easy for them to make mistakes. They end up taking more time than average to complete claims and often find themselves re-submitting ones they’ve sent out. The cycle continues until someone steps in to offer better training, but these mistakes can be avoided if new team members are given proper guidance when onboarding.

This is true for long-time billers, too. As new regulations roll out and industry standards change, the people on your billing team are going to look to you for direction. Make sure you’re providing them with all the support they need to succeed. Consider providing quarterly training to cover new initiatives and go over the expectations you’ve set for your staff. Maybe send a few people to conferences and special training opportunities as well.

2. Duplicate billing

It’s worth training physicians and nurses in all parts of the billing process. This encourages better communication across different teams and increases the chances that someone will catch an error before a claim gets sent out. However, it can increase the likelihood of duplicate billing.

Duplicate billing hurts your business in more ways than one. First, it prolongs the billing process and causes confusion for both your staff and patients. Second, you can get fined for duplicate billing if it goes unnoticed by you, but a patient or payer fights the charges. Additionally, you risk losing patients to competitors. If someone has a negative billing experience with you, they’re likely to consider visiting other medical providers who can perform the same services.

Fortunately, you can prevent all these outcomes. The best way to do so is by establishing a clear protocol for how claims will go out. Once you identify the key people whose responsibility it is to send claims, the likelihood of others sending duplicate claims will largely decrease. You can also improve how you track claims as they’re created and when they’re being reviewed by payers.

3. Not verifying patient information – including insurance

This is the simplest billing mistake of all, but it adds up significantly. All it takes is for a patient to forget a signature or not fill in all their insurance information for your billing process to get backed up. It’s also possible that a patient’s insurance information has changed since their last visit. And even when everything looks right, your staff has to verify every single patient form they receive.

Otherwise, you risk running into a pile of denied claims to go back through one by one. This hinders the patient experience and causes a lot of frustration for your staff, too.

Luckily, it only takes one or two extra steps in your billing cycle to keep your staff from starting the eligibility and claims filing process all over. Remind your team to confirm patient insurance before an individual is received for treatment. Set the expectation of photocopying insurance during a patient’s first visit and to verify insurance when making future appointments.

There’s no way to guarantee that absolutely no billing mistakes will affect your revenue cycle. However, there are plenty of opportunities for improvement when you’re able to pinpoint the biggest blockers in your workflow. Take a serious look at your revenue-related operations and identify where you can clean things up, then get to work.

outsourcing operations

Outsourcing Operations: 5 Questions to Ask When Selecting a Vendor

You’ve decided it’s time to lighten up your workflow and invest in outsourced processes – now what?

First, you need to clearly identify what pieces of your workflow you want to automate or have a vendor handle for you. Next, you need to establish a plan of when/how you’d like this change to happen. Finally, you need to find the ideal vendor.

Here are five questions to ask a vendor when you begin outsourcing operations.

1. What level of access will my team have to patient information?

This is the most important question to ask. Whether you’re looking to automate parts of your RCM cycle or you’re interested in improving the quality of care your team provides, your team should have access to all the information they need.

It’s hard for billers to manage payments or nurses to understand a patient’s condition if they’re constantly having to dig for the claims and codes they need. The whole point of outsourcing is to simplify your workflow – and that means making sure access to important information becomes more available, not more complicated.

2. Will your company train my team to use your product?

You need training just as much as you need proper access. It’s not every day you change how things are done in your office. Team members will need time to adjust to the change, and they’ll also need someone to guide the way.

Taking on the training yourself leaves practically no room in your schedule to handle other aspects of the business, and you risk missing key details. Bringing the vendor in to walk your team through the process is much easier. It establishes a strong working relationship with whom you’re outsourcing, and it encourages a positive reaction from your team to this new way of doing things.

3. How knowledgeable is your staff about my industry?

It’s one thing to know how a product works and another to understand the industry problem it solves. Make sure the vendor you’re working with has a deep understanding of your business. Their team needs to be highly educated in industry standards and regulations. They should be aware of any major shifts going on and prepared to answer any questions you have about how they affect your outsourced workflow.

4. Do you offer any additional services?

The only thing better than improving one part of your workflow is improving multiple parts. One vendor may be able to do that for you, but you won’t know until you ask.

Chances are, if they can help you create more clean claims, they can also help with resubmitting denied claims. The same goes for vendors who specialize in staff management/training or ways to enhance the patient experience.

5. How are performance reports generated?

The final thing to ask a vendor is how they manage performance reports. Some vendors will offer regular reports for their products. This provides customers the data they need to better understand how a certain tool/service is impacting their organization. Other vendors leave performance reporting up to the consumer. They have a more hands-off approach, which can put a strain on the customer experience.

And ultimately, a negative experience is what these questions aim to avoid. To get the best results possible, you need to find the best vendor to fulfill your business’s needs. Mentioning the points shared above will guide you in the right direction.