In today’s cardiology practice, there are tremendous resources devoted to continuing clinical education and obtaining the latest, state-of-the-art equipment, but is there the same passion for ensuring business operations? Specifically, is AR handled as a top priority? Many practices use the “it’s how we’ve always done it” approach and may be missing some extraordinary opportunities to optimize the RCM process.
Before you say that isn’t the case, consider this: 50-60% of denied claims are never reworked and are simply abandoned, according to the Medical Group Management Association (MGMA). Even more stunning, per the 2019 CAQH Index on Conducting Electronic Business Transactions, only 13% of practices industry-wide use electronically automated prior authorization solutions and instead manage the entire process manually.
So how do you stop and assess your current business flow?
Review Infinx’s MedAxiom webinar from September 2020, entitled “Looking for Revenue? Find out how to Collect on Unpaid Aging A/R During the COVID Crisis”. Find out how you can quickly collect on outstanding 3rd party aging receivables using proprietary software, optimized with artificial intelligence and machine learning capabilities that maximize your A/R collections and profits earned.
Start at the Beginning
No place to start like the beginning. Whether the patient is self-referred or referred from their primary care doctor, your practice is responsible for checking information to make sure that everything is precise and accurate thereby ensuring fast reimbursement and minimal reprocessing.
1. Ensure All Patient Information is Current and Up-to-Date
Whether you obtain information from the referring doctor or the patient, always verify and re-verify insurance eligibility and patient demographic information. Insurance verification should be done before each visit and follow-up appointment to ensure no changes would alter the prearranged payment understanding.
2. Collect All Pertinent Amounts Due Before the Patient Encounter
With today’s automation capabilities, it is virtually effortless to closely (if not precisely) estimate the patient’s portion due and that money should be collected before the patient arrives for their initial treatment or surgery.
Train all employees to handle money conversations politely, yet assertively, and recognize that most patients don’t understand their health insurance. This creates a terrific opportunity for your practice to educate and gently guide patients through the third-party payer maze, improving collections, and the patient experience.
3. Ensure Prior Authorizations are in Place
As stated above, 87% of practices rely on manual prior authorizations — this is cumbersome and time-consuming. By initiating an advanced automation solution using artificial intelligence (AI) with machine learning capabilities, prior authorizations can be processed and followed up in real-time with status available immediately 24/7.
After the Patient Encounter
Revenue Cycle Management
4. Enlist the Highest Quality Coding Expertise Available
Accurate coding comes from judicious education and follow-up to stay on top of regulatory changes and industry trends. Using a certified coding team guarantees coding to the highest level and managing the flow of documentation between multiple locations.
5. Revise Patient Statements to Clearly Communicate Billing Information
Again, even though we deal with insurance payers routinely and are well-versed in the jargon, this is usually not the case with patients. It’s important to remember that they receive a lot of information following care, and much of it isn’t very clear. Review your patient statement to communicate clearly and succinctly to remove any obstacles to payment.
6. Send Statements Daily (or at least weekly), not Monthly
Once insurance payment has been received, a patient statement should be sent immediately if portions are still due. Batching those statements to be sent at the end of the month adds additional days to the billing cycle.
Also, patients often have a fading sense of value; the further it gets from resolving their problem. By moving quickly, there is a better opportunity for payments to be concluded.
7. View the Claim Denials with Fresh Eyes
As we mentioned earlier, more than half of denied claims are left unworked, and the money merely uncollected. This is often due to too little time or lack of understanding on how to proceed.
Instead of treating denials as an afterthought, consider automating the process using an advanced electronic system to identify the next best action, update missing information, and resubmit claims in real-time. Infinx has a 95% quality standard rate with its artificial intelligence (AI) driven software and reduced >120 days AR by 60% in less than six months.
8. Redefine Uncollected Debt
Apply an Insurance Discovery Solution to the uncollected amounts due before sending that money to collections where your return is cut in half (or more) if collected. By leveraging AI and machine learning technology with experienced specialists, a tech-enabled services solution can scour insurance clearinghouses to locate undisclosed coverage before it turns into charitable care.
As we play out 2021 with all of its unusual circumstances, we continue to experience fee schedules that are stagnant or declining and change the foundational payment structure. Now is the time to review business operations and consider adapting to advanced automation and AI in the healthcare payment lifecycle where it would be beneficial.
With automation and AI-driven technology, cardiology practices can optimize the RCM process and focus their administrative support on higher-level functions, such as the patient experience, that benefit the bottom-line and better position the practice for value-based care criteria.