Without strong revenue cycle management and oversight, from intake to treatment, discharge, billing and payment, it doesn’t matter how much cash your behavioral health center has. Lacking proper management could be throwing up obstacles, including late payments and denials that significantly reduce your cash flow and your profits.
Revenue cycle management has its challenges, so we’ve compiled a few tips to help you more effectively manage yours. Implementing some simple changes, starting when you’re first contacted for treatment, can help you:
- Improve efficiency
- Decrease denials
- Increase patient satisfaction
- Increase your cash flow.
The challenges of effective revenue cycle management
A number of hurdles can get in the way of effectively managing your addiction treatment center’s revenue cycle. Each can lead to increased administrative task time for your employees and delayed and/or denied payments. Have any of these affected your center directly? How have you overcome them?
· Failing to appropriately verify patient eligibility: Verifying that a patient’s information is correct and complete is a vital initial step to ensuring timely claims processing and payment.
- Not monitoring the claims process from beginning to end: Not being able to easily see where a claim is in its lifecycle can lead to confusion, time wasted and denials, if there’s a problem with the claim, and you can’t figure out quickly where things went wrong.
- Ignoring rejected claims: Claims can be rejected as the result of simple coding errors and mistakes like switching numbers and leaving fields blank. How easy is it for you to gather the correct information and resubmit the claim? (Or keep the mistake from happening in the first place?) Do you take the time to resubmit claims, or do you write them off as losses?
- Being out of touch on current payer requirements: As we’ve discussed in earlier posts, your staff needs to stay on top of changes to regulations and requirements, both from government and private insurers. They must be prepared to make all necessary process and systems changes as soon as they learn about them.
- Not recognizing trends: When your overworked administrative staff process large numbers of claims, they may be repeating processing errors that affect your claim payment rate. These errors could be eliminated easily, if your staff could only take the time to see them. Processing claims in-house can also cripple your ability to see trends on a larger, national and/or multiyear scale.
Use your earliest patient contact for better revenue cycle management
Many of the challenges we listed above originate with your first contact, when the patient or a loved one contacts your treatment center to arrange for services.
At this step, your staff gather the patient’s insurance and personal information, verify their eligibility and begin creating a plan for admission. This information is shared across your entire organization. If the information gathered is incorrect, not verified or incomplete, it’ll be wrong throughout the patient’s treatment cycle, leading to uncertainty regarding treatment, longer payment times and more denials.
What should you gather?
The intake information and forms your staff should be collecting includes the following. The exact information you require may differ slightly, but this list gives you a starting point.
- Patient demographics
- Medical insurance information, necessary to determine eligibility for treatment:
- Co-insurance benefits
- Out of pocket expenses
- Coverage of specific procedure codes
- Any accreditation requirements or specific plan guidelines
- Validating the patient’s identity to avoid fraud possibilities
- Any paperwork requiring patient/guardian’s signature
- HIPAA Notice of Privacy Practices acknowledgement
- Consent to treat
- Financial assignment of benefits
- Release of Information form
- Power of Attorney
- Authorization to Appeal
Next steps to ensure effective revenue cycle management
Making improvements to intake is just the first step; you need an eye on every one of your systems and processes. Take the time to evaluate what’s working well and where your bottlenecks may be. As you thoroughly evaluate all of your systems, review and strengthen all of your processes and implement a system of checks and balances that prevent errors and omissions, you’ll see more accurate, timely and compliant claims reimbursement and ultimately, an improvement in the management of your revenue cycle, your cash flow and your profits.
If this sounds a bit overwhelming, partnering with an experienced revenue cycle management company might be what you need. We can help. Infinity Behavioral Health Services has the industry experience to send you down the path to revenue success. Call us today at (866) 677-5264 for more information about strengthening your intake process and management of your entire revenue cycle.