Fortify Your Healthcare Revenue Cycle – Explore The New Means Of Running A Practice
Health care revenue cycle
It is the crux of every profitable practice. It starts even before the time patient comes into the facility. Once the patient contacts the facility and schedule an appointment, the registration process begins. Type of registrations vary from facility to facility. These days, we see virtual registration forms like typable pdf online forms being given to the patients which they can fill up at their home relaxed. However, there are still practices who do paper registration forms which are filled up by hand, old-style and quite frustrating to the patient. Depending on age and other disease conditions, it can be tiresome for them to fill up handwritten forms. Completing the paperwork itself will take ages for the patient and your staff. If the patient has a poor penmanship, the staff will have to spent hours trying to decipher what is written in the paper and ends up committing data capture errors in patient’s date of birth, address, spelling of the name, insurance ID etc. Many at times with a wrong address entered, the bills sent to the patient might not even reach them and there will be added cost for the clinic.
Next step is scheduling an appointment. Since the healthcare revenue cycle is already kicked off, making sure the patient keeps up the appointment is very crucial. Either have your staff call them with a reminder on the appointment or invest on automated reminder services which can send a text or a voice call to the patient regarding the time and date. Most automated services give the patient a chance to reply with an acknowledgement to confirm that they will come for the appointment. This is very important considering the slot allotted for the patient might get wasted if he / she can’t show up. One can very well push another patient to that slot if the staff gets to know beforehand. And if at all the patient doesn’t make it to the appointment, let there be a protocol on how to manage such scenarios, since retention of the new patient is very important to your health care revenue cycle. May be the staff can give a call the next day and talk it out with the patient and have another appointment fixed addressing their concerns.
Obtaining all the insurance information necessary before the time of appointment is another factor which can save time for your staff. If a preliminary registration gets done by phone or online platform, the staff can preauthorize whether your facility is enrolled in the network of the insurance provider the patient has subscribed. Coming all the way to the office to find out that the facility is not covered by the patient’s provider can be quite annoying and misuse of time for the patient and your staff. Being able to do an eligibility check of the patient’s insurance plan prior to appointment can help in educating the patient about what kind of treatment and coverage they are entitled to. This avoids unnecessary confusions and confrontation in the future with the patient regarding co – pays.
Once the patient is in the clinic for their first visit, as a provider do make sure that your notes on the patient’s disease conditions are elaborate and comprehensive. The electronic health record should be crisp and complete with the diagnosis, treatment plans, tests required and follow up planned, so that a medical coder can easily assign codes to the services provided without dilemmas.
Once the Codes are assigned and charges captured based on the health records, billing can be done for the claim request. Most clinics use integrated software to make sure that the process is clean and standardized. Also, that the insurance status of the patient is still active to receive payment for the services. The claim and bills are rechecked or scrubbed to make sure that the procedure codes and the bills tally and everything matches the requirements put forward by the insurance company. These days claim submissions are done electronically with help of claim generating software’s and there is a lot of clarity in the process.
Once the claim request is sent, the clearing house of the insurance company look at the details in the claim to compare the benefits which the patient is eligible, and the treatment you have provided to decide which all treatments can be reimbursed. If they find the details in the claim doesn’t come under the package, the request may be denied and sent back to your claim clearing house. This is exactly why your staff should keep tracking the status of the claims sent because, any denied claim needs looking into. Most often this step is ignored, and the entire healthcare revenue cycle gets delayed resulting in loss of income. Every rejected claim should be revised and fixed as quickly as possible to on a regular basis to ensure smooth running of the revenue cycle.