How To Evaluate Claim Lifecycles to Maximize Revenue: Part 2

healthcare workers evaluating claim lifecycles

Claim lifecycles are very complex. There are many opportunities for error and improvement throughout the process. These opportunities live both at the clinical and billing levels. Mistakes can ultimately cause claim denials, or delay payments for months. In the healthcare industry, billions of dollars are left unaccounted for each year because of these mistakes, which can cause bad debt to increase rapidly.

Closely examining each stage of patient claim lifecycle is the key to taking advantage of every revenue opportunity. In part one of this series, we looked at the pre-appointment stage of the claim lifecycle. Now, we will look at the appointment stage.

Accurately capturing charges

When charges aren’t accurately captured, it can impact an organization’s bottom line. Undercharging and overcharging are both issues that can affect profitability. The revenue cycle has many moving parts involving automation and human intervention. The opportunity for error is high, which can result in billable dollars left behind.

According to HFMA, about 1% of net patient revenue is lost because of errors related to charge capture with many leaders reporting that their organization’s charges were either under or over coded. This not only represents leaked revenue but presents a significant compliance risk as well. Performing a regular audit of charge captures can help streamline internal workflows, which reduces processing time and improves the revenue stream.

Coding and documenting the claim

Better management of clinical documentation increases a practice’s bottom line by decreasing the time it takes to get claims paid and reducing claims denials. Strong documentation management makes it easier to create financial stability in a medical practice and helps streamline the revenue cycle. The best clinical documentation is an integrated approach that incorporates all office components.

It is critical to have tools in place to make sure that charges are captured, and documentation supports the care that was provided. Medical coders rely on charge entries from many sources including physicians, electronic health records, and clinicians. This makes the risk of human error very high. Medical necessity denials are one of the largest denial categories, with poor documentation being one of the main factors.

Ensuring that documentation is clear, consistent, complete, reliable, legible, precise, and timely is key. It allows practices to be able to see appropriate reimbursement and also increases the quality of care offered to the patient. 

Point of service payments

Collecting some amount from patients at the point of service offers several benefits to practices including reducing accounts receivable, increasing cash flow, reducing medical billing and back-end collection costs, decreasing the administrative burdens of tracking and writing off bad patient debt and managing the growing portion of practice revenue generated from patient payments. All of these factors can help a practice maintain or improve its financial viability.

The best way to improve upfront patient collections is to communicate effectively. Talk to patients about costs, insurance coverage, payment policies, how they can make payments, and deadlines. The earlier that an organization starts the patient financial conversation the better. If there were no pre-appointment financial discussions, discharge is the last chance to engage with a patient face to face to put a personalized payment strategy in place.

Delaying this conversation until after the visit can be more difficult and can result in unpleasant billing surprises for patients. By acting as a partner to the patient and helping them understand their responsibilities, an organization will not only increase patient collections but provide a more compassionate financial experience in the process.

Stay tuned for part three of this series, where we will cover the post-appointment stage of the claim lifecycle.

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