By Ann Knutson, CPC-A
The healthcare revenue cycle includes all administrative and clinical functions that involve capturing, managing, and collecting the provider’s/facilities revenue. The cycle includes three distinct parts of the practice/facility that’s referred to as the front-end, middle, and back end. Unfortunately, most of the time there is little coordination between the three areas which can lead to more claim denials and lost revenue for the practice/facility. Therefore, adding a revenue integrity team to your practice/facility dramatically improves operational efficiency, compliance measures, and reimbursement rates. Members of the team must have extensive knowledge of and be familiar with the complete healthcare revenue cycle.
In order to foster collaboration between all three areas of a practice/facility that affect the revenue cycle, specific training needs to be implemented for staff, along with coding and documentation education for providers.
Specific staff training includes:
- Keeping up to date on billing requirements, such as coding guidelines, billing regulations, and insurance payer policies.
- Reimbursement updates, such as data showing rate of reimbursement vs. denials/rejections.
- Key performance indicators, such as data regarding common billing or coding errors leading to claim denials and rejections.
- Job expectations, such as all billing employees must know every aspect and function of their job in detail.
Provider education involves:
- Chart reviews to verify proper documentation.
- Quarterly meetings regarding coding guidelines, payer rules, and the importance of medical necessity.
Furthermore, creating templates and tip sheets for billers, coders, and providers improves operational efficiencies, clean claim submission, and proper provider documentation. It also decreases claim denials and puts everyone in the practice/facility on the same page.
In addition, the collaboration between coders and the accounts receivable team is crucial to improving reimbursement rates, the outcome of claim appeals, and compliance with regulations. It can also help to reduce the number of claim denials and rejections. Plus, medical coders are able to share their expertise regarding regulations and proper coding with the Accounts Receivable (AR) team members. This helps the AR team with reconciling claim rejections and denials along with properly submitting appeals. On the other hand, the AR team can inform coders of the current codes or coding combinations that are being rejected or denied by payers. With this vital information, coders can make the required coding and billing changes as they enter the charges and submit the claims. This can greatly improve the rate of clean claims submission. (AAPC, 2021)
Therefore, it’s in the best interest of a practice/facility to implement a revenue cycle management team that is familiar with the entire revenue cycle, fosters collaboration between all areas of the practice/facility and providers, and maintains open communication between all departments in order to maximize revenue cycle efficiency and reimbursement. For assistance with maximizing your revenue cycle efficiency, please contact us at MedCycle Solutions.
For more information about maximizing revenue cycle efficiency, please visit www.aapc.com.
Ann Knutson, CPC-A is an Accounts Receivable Specialist at MedCycle Solutions, which provides Revenue Cycle Management, Credentialing, Outsourced Coding, and Consulting Services to a number of healthcare providers in a variety of specialties. To find out more about MedCycle Solutions services please visit www.MedCycleSolutions.com.
Have you increased the amount of Telehealth visits with your patients?
If not, you and your patients may be missing out.
Over the past two years, the COVID-19 pandemic has changed the landscape of patient care and increased the need for providers to utilize virtual healthcare services. Due to the Public Health Emergency (PHE) policy update, many healthcare practices had to shut down, pause or augment their services with telemedicine to provide flexibility in patient support.
Here are four ways Telehealthcare has been implemented to provide safe, necessary care for patients while augmenting revenue.
- Stop the Spread of Contagions
With the need to quarantine, social distance, and reduce the risk for clinic staff and patients, many health practices adapted ways of providing non-emergency services. For patients with (possible) highly contagious diseases, such as COVID-19, many clinics ask patients to schedule virtual appointments to avoid possible infections and further outbreaks. This allows for keeping both the staff and patients as safe as possible while still receiving necessary treatment.
- Provide Essential Health Services
For those patients that suffer from White Coat Syndrome going to the doctor’s office causes a great deal of stress and anxiety. By allowing patients to access care in the comfort of their own home for managing chronic health conditions, routine services, prescriptions, and referrals for testing and labs, this allows for greater patient access. Plus, it has the added benefit of reduced overhead costs associated with cleaning and turning exam rooms.
- Provide Physical and Occupational Therapy Healthcare
Accidents happen. Whether motor vehicle accidents, workplace injuries, or trips and falls – PT and OT is imperative to keep patients mobile and progressing. Many providers offer hybrid services with virtual appointments for patients to keep them mobile while supervising and adapting exercises in their home environments.
- Provide Mental and Behavioral Healthcare
Mental and behavioral healthcare is one of many patient-care needs. This is especially true for long-term residential care. Many nursing home facilities transitioned to telemedicine during the COVID-19 pandemic.
The U.S. Department of Health and Human Services, via the Centers for Medicare & Medicaid Services (CMS) heavily promoted the switch to Telehealth as infection prevention and control measures. They’ve made digital resources available that offer behavioral health and best practice guides for long-term nursing homes, a telemedicine tool kit, as well as other guidance.
If you think your practice and patients can benefit from implementing telehealth visits stay tuned for our next article on 5 Resources for Implementing Telehealth & Telemedicine.
Mariellen Mezzacappa has a variety of experience in the medical field. She has worked for doctors, hospitals, pharmacies, and insurance companies. Her experience includes bill review and coding with a wide range from EAPG 3M, DRG, Workers Compensation to Appeals and coder Affidavits for Litigation. She provides verification of code selection for operation reports, documentation review, and credentialing. Additionally, she has worked on operation policies, compliance training, and project management.
MedCycle Solutions provides Revenue Cycle Management, Credentialing, Outsourced Coding, and Consulting Services to a number of healthcare providers in a variety of specialties. To find out more about MedCycle Solutions services please visit www.MedCycleSolutions.com.