The more efficient a health care revenue cycle process is, the more successful it will be in processing claims, getting money in the door and ensuring optimal outcomes for patients and residents.
The long-term post-acute care (LTPAC) realm is no exception. Revenue cycle professionals at LTPAC organizations know just how important it is to collect revenue in a timely manner while minimizing lost or uncollectible revenue.
While there are many ways to approach this challenge, building automation into your revenue cycle process (i.e., search capabilities and charge accuracy) is a proven strategy that will deliver bottom-line ROI for your organization—and a quality financial experience for residents and their loved ones.
That said, many LTPACs continue resisting revenue cycle automation improvements, claiming that costs associated with acquisition of associated technology, integration and training are too high to bear—particularly during down cycles. Yet, some industry watchers estimate that up to 80 percent of LTPAC billing and financial workflow will be automated within the next several years. Clearly, automation in the LTPAC industry drives efficiency from upstream processes like admission all the way downstream to automated payment posting and everywhere in between. It also largely eliminates human error from mis-keying information through manual inputting—and, it frees limited staff from having to perform time-intensive tasks.
Opportunities for revenue cycle automation exist throughout the care continuum, so now is the time to get on board. Not sure where to start? Consider these five steps to building automation into your LTPAC revenue cycle process:
1. Conduct a through gap analysis
This means identifying any and all holes in your revenue cycle process – from eligibility and pre-billing to timely authorization and beyond – then determining where automation could help fill those holes. Even if your organization has used the same revenue cycle processes for years, there will always be opportunities for improvement. So, examine those processes through a critical lens and determine the appropriate remedial steps. By performing a gap analysis, you may uncover specific reasons why certain issues exist—for example, particular payers. At that point, you’ll know that working directly with those payers could alleviate these issues in the future. And of course, you could automate the entire process, which would go a long way toward preventing those issues from occurring over time.
2. Integrate automation technology into both internal and external revenue cycle processes.
For internal processes (e.g., Triple Check), examine your current revenue cycle technology (e.g., an EHR solution like PointClickCare®) to determine if you can automate processes such as claims scrubbing and pre-payment. For external processes (e.g., eligibility searches, authorization portals, denial management), you’ll likely need to identify a suitable “bolt-on” technology partner who can integrate the right supplementary technology into your current infrastructure. Generally speaking, anytime your organization needs information that’s not contained within your EHR or other systems and requires entities outside your organization to provide it (e.g., eligibility), you’ll need a third-party vendor to create an integration or integrations.
3. Consider using a clearinghouse for claims submissions.
In the revenue cycle realm, clearinghouses are akin to wholesale distribution centers which collect claims from healthcare organizations like LTPACs, distribute to various payers, collect data from each claim and then electronically provide information such as claims status and electronic remittance back to the submitting entity. Submitting claims electronically (i.e., through automated means) to a clearinghouse is one of the most efficient ways to submit, track status and ensure timely adjudication.
4. Automate your cash remittance process.
This means making sure all your remits (i.e., both cash and EOB payments) come back to your LTPAC electronically. You can also automate the process of downloading reimbursement data.
5. Build automation into your denials management process.
It’s critical to work denials efficiently, rather than spending valuable time manually pulling EOBs and combing through them for insights. By automating your denials management process, you can quickly identify billing issues and process improvement needs and improve payer knowledge.
Finally, it’s important to stress that revenue cycle automation can boost productivity—not replace jobs. By automating revenue cycle management processes like those mentioned earlier and making sure the right people are in the right roles to ensure timely execution, your LTPAC can operate more efficiently and profitably. Additionally, employees will be more engaged in meaningful work they actually enjoy, and clients and their loved ones will receive timely and relevant information they need.
Do you have questions about automating your long-term care or skilled nursing revenue cycle, or other revenue cycle management challenges? Read our e-book, “Six Strategies to Optimize Your LTPAC Revenue Cycle Process” or call Richter’s revenue cycle management consultants at 866-806-0799 to schedule a free consultation.
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