Looking for Ways to Improve Your Sleep Medicine Practice’s RCM? Here are 5 Areas to Focus On

Today, like many specialties, sleep medicine is faced with falling revenue as insurance company guidelines chip away at the reimbursement you earn when treating patients. To complicate things further, sleep medicine is experiencing a shift in how care is delivered due to a once-in-a-century pandemic.

So how do you protect yourself and your practice? By ensuring that your overall billing lifecycle is working in top form and no preventable issues are falling through the cracks.

5 Places to Focus Your Attention

All things being equal, aside from contractual insurance changes, declining revenue can almost always be traced back to operational systems and billing processes that need to be identified and improved.

Take for instance, prior authorizations! Only 13% of practices use a fully automated prior authorization process that could alleviate much of the administrative time and mistakes in a manual system. But practices have been slow to embrace the advanced technology available through cloud-based software, such as Infinx’s Prior Authorization Software solution.

We have identified five areas where attention paid can have a seriously positive “dollars and cents” impact on your sleep medicine practice.

1. Double-Check Insurance Eligibility – And Then Check It Again!

Securing real-time, accurate and valid insurance and demographic information about your patient is critical for the entire reimbursement process.

Every practice should start by checking and re-checking eligibility so that you can be assured patients have valid coverage. By using a transparent insurance verification and benefits eligibility automation package, your practice will be able to track and confirm precise patient coverage details immediately while avoiding later denials due to ineligibility, including:

  • patient’s eligibility and dates of coverage,
  • primary or secondary insurance relationship
  • co-pay and/or co-insurance due,
  • annual deductible met and remaining, and
  • any out-of-pocket maximums.

Eligibility changes happen all the time, and patients may not even understand the implications. By checking it during each encounter, either by phone, for scheduling or telehealth purposes, or in person, you can be assured that you are being presented with the most accurate information.

2. Be Sure to Capture All Charges

It seems counter-intuitive, but charges often get missed when providers are rushed, familiarity has set in, or when providers choose not to chart within 24 hours of the patient encounter. Procedures, tests, equipment, or medications are missed or omitted, and that costs money. Missed charges add up quickly and rob you of time spent, but often supplies, medications, etc., that are inventory expenses of the practice.

Communicate with your business team — they will often tell right where the holes are, and you can discover things that are getting missed within your practice or, even better, perform a systems’ audit that follows the superbill from inception through claims management and collections.

3. Collect All Patient Portions Due Up Front

Patients are absorbing more of the financial responsibility for their care, and sleep medicine providers need to be proactive in educating them on their increasing financial role. It has never been more important to set the expectation that patient portions are due before the service is provided. An effective way to enhance the process is with real-time estimates delivered prior to any scheduled care, which 90% of patients will willingly pay, especially when given online payment options.

4. Routinely Monitor the Coding and Billing Function

Whether this is done in-house or by a third-party RCM partner, routinely monitor the coding and billing process from start to finish to ensure precision. This means that once the patient encounter is complete, the superbill is followed through the coding function, the claims submission process, and finally through A/Rs and collections (if necessary).

It’s important to have a trusting relationship with employees and third-party partners, but it’s also key to verify that the job is being completed satisfactorily. This gives you peace of mind while ensuring your team is properly trained and well-functioning.

5. Be Sure to Review Financial Business Indicators

There are several key measurements that give you a bird’s eye view of how your practice is running. Keep a careful eye on these numbers:

  • Daily Net Production (charges – payments – adjustments + refunds)
  • Monthly production by provider
  • Outstanding AR breakdown
    • ARs over 90 days below 25%
  • Number of claims denied and the reason why
  • Missed appointment and no-show rates
  • Overtime hours

For sleep medicine practices, it’s important to verify that business functions are working properly and audit systems are in place to ensure that workflow is being performed as set in your policies and procedures. As in any organization, turn-over happens, and systems can be interpreted differently or changed without your knowledge. By being proactive, you can be sure that your office is running as intended.

Contact us today to learn more about our automated, real-time Insurance Verification and Benefits and Patient Payment Estimation solutions for your sleep medicine practice.

About the Author

Infinx
Infinx Healthcare provides innovative and scalable payment lifecycle solutions for healthcare practices. Combining an intelligent, cloud-based platform driven by AI with our trained and certified coding and billing specialists, we help clients realize revenue, enabling them to shift focus from administrative details to billable patient care.

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