● Cover Story: Revenue Cycle Management Roundup
provider coding, as well as to decrease costly errors resulting from ineffi ciencies.
Whether it is staff training, process analysis or IT implementation, providers must plan carefully during this transition to avoid reimbursement disruptions. We can learn from other countries and lessons from their ICD-10 experiences, which have shown that early preparation and eff ective technology implementation are absolute success factors.
Steve Francis, president and GM, GMC North America
Speeding the revenue cycle starts with the EOB Increasing the effi ciency and speed of the revenue cycle is a top priority for healthcare organizations – and rightfully so. In today’s environment, explanations of benefi ts (EOBs) don’t just represent an outbound communication with your customer. It is important to consider the inbound aspect of that communication, particularly as it requires customer response to keep the revenue cycle moving along. How you populate and deliver the contents of the EOB are equally critical factors in getting patients to pay their bills – and making that experience as personalized as possible will improve the chances even more. Additionally, adopting a multichannel approach to EOBs has become increasingly necessary. People interact with their EOBs through a variety of channels: print, email, mobile phone or tablet. Combining the printed EOB with electronic payment options – such as having a QR code on the EOB for online bill payment – speeds up the remittance process. T e format of the EOB can also make a big diff erence in
the remittance process. When a patient disputes a line item on his or her bill, often all the other line items are left unpaid while the charge is disputed. T is slows down the revenue cycle tremendously. Separating out costs on the EOB provides a clear path for patients to pay the charges they agree with, even while disputing some of them. Statistics show that 95 percent of transactional documents
are opened and read. Providing patients the opportunity to interact with the communications you deliver through their method of choice, assuming it meets compliance, will help achieve optimal RCM operations.
reimbursement for certain services may decrease. Until practices are comfortable with the new code system, it may take longer to submit claims, correct rejections or appeal denials – all of which are critical to maintaining a healthy RCM. Facing this reality, practices must tighten their RCM strategies. Look at which processes are manual and which could be automated through partnerships with vendors such as clearinghouses or practice management (PM) systems. T ere is no better time than now – before ICD-10 adds extra complexity – to leverage technologies to automate processes, such as: • Denials: Knowing which claims were denied is only the fi rst step. Tools off ering denial tracking and correction help prevent reoccurrences and keep the revenue cycle strong. Implementing these tools will allow practices to understand their denials pre-ICD-10, helping with a smoother transition.
• Appeals: Practices tackling appeals manually should consider tools with pre-developed letters that populate patient and denial information. T is way appeals can be completed quickly, allowing practices to focus on other tasks that may be taking longer due to the ICD- 10 transition.
• Eligibility: Eligibility is another example of a manual process that can be automated while preparing for ICD- 10 changes. Ineligibility is one of the most common denial reasons. Verifi cation technology reduces denials, supplying eligibility information before providing services and can tie directly into some PM systems.
Technology can help assist practices during the ICD-10 transition. Practices getting comfortable with RCM technology now are more likely to keep their revenue cycle strong once ICD-10 arrives.
Denise Junkin, product manager, Navicure
Lawrence Martin, VP, product management, QuadraMed
Self-service technology enhances revenue-cycle processes
As payment responsibility shifts more to patients, hospitals
Denise Junkin, product manager, Navicure
Let automation help steer the revenue cycle through ICD-10 T e transition to ICD-10 could have major consequences
for RCM if your practice is not prepared. As part of transition planning, anticipate that denials will increase and expected
10 June 2013
are implementing strategies to collect more up front. T is paradigm shift makes sense because the likelihood of collecting improves if patients pay before leaving the hospital. Organizations are realizing that it’s now essential to involve patients early in the revenue cycle process, moving past the traditional practice of involving patients only at the back end of the revenue cycle. When moving collections eff orts up to pre-registration and
registration, some executives worry about overloading staff . For many, the solution is self-service technology. Providing patients with opportunities to review fi nancial information, complete forms and make payments before a visit off ers the following benefi ts:
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