In today’s economic environment, the timely collection of all earned revenue is not a luxury—it’s a necessity. That’s true for all practices – not just specialty ones. At Regional Urology Enterprise, for example, I’ve had to navigate the revenue pitfalls associated with imaging and radiation treatments. What I’ve learned, though, is practices that leverage technology to improve efficiency, streamline workflow, and proactively identify and respond to systemic issues can ensure they collect all the money they earn.
I consider my practice’s automated clearinghouse as one example of technology that kills two birds with one stone: it improves our overall performance while it also enhances the bottom line. We use it in a variety ways, but most notably to:
- Proactively identify problems. Our practice actively works with many of the system’s reports to identify problems with claims in real time. We not only look at specific problems with individual claims, but also try to indentify more global issues that need to be addressed. For example, we run reports showing the number of claims with inaccurate demographic data—wrong date of birth, for instance. These reports highlight potential problems with front-end data collection and signal the need for training to ensure front desk staff more accurately captures demographic information at patient check-in.
- Submit the cleanest claims. We also rely on our clearinghouse’s claim scrubber to support the cleanest possible claims. The scrubber’s payer-specific information identifies when a claim does not meet the requirements of a particular payer and describes the exact nature of the problem. By uncovering errors up front, staff is able to quickly fix any issues before submitting the claim for the first time—instead of waiting 30-45 days to find out there is a problem.
- Verify eligibility automatically. Through the clearinghouse, we also run eligibility reports each day that automatically verify insurance coverage for the next day’s schedule of patients. This report quickly identifies any problems with a patient’s insurance coverage so staff can address insurance issues with patients when they arrive for their appointments, as opposed to waiting until after a claim is denied.
As a result of these efforts, our practice has reaped significant benefits. Our days in A/R have dropped to an average of 30 to 60 days—a reduction of as much as 50 percent in three years. The process of submitting claims has also gotten easier across the board.
While specific, complex procedures—such as radiation treatments and imaging—still present opportunities for error, the automation from the clearinghouse helps us catch and correct any errors upfront. The result is a more accurate claims submission process, and a more efficient and profitable revenue cycle.