That requires many things: Confirming that patients are covered for the care providers deliver, submitting accurate claims that trigger prompt payment, posting payments quickly so resources are immediately available, ensuring no cash is left on the table.
Perhaps the most effective approach to managing all aspects of the revenue cycle is incorporating a Web-based application to manage receivables for improved cash flow and increased profitability.
Efforts to ensure timely payment must begin even before providers see the patient. Eligibility verification products assist front office staff in confirming coverage and securing accurate demographic information at patient check-in. It is vital to obtain this information while the patient is in the office, so staff can identify what information is missing or what data needs to be corroborated.
Having real-time access to critical patient and insurance information — including coverage dates, benefits, ceilings, co-pays and more — enables billing staff to file a claim correctly the first time. By identifying service eligibility, they can often avoid claim rejections, the need to re-contact the patient, the need to re-bill the claim, and lengthy resubmission and re-adjudication processes. In fact, patient eligibility errors can extend a normal 10-day payment cycle to 45 or even 60 days.
Another factor that often interferes with prompt payment is the unsuccessful delivery of claims to the payer. While electronic submissions and remittance are designed to expedite payment, Web-based solutions must demonstrate a proven track record of consistently and reliably retrieving claims from a practice and delivering them to the insurer. A dependable product is critical for monitoring timely delivery and alerting staff to problems payers may have receiving a claim.
While many practices are auto-posting a significant portion of their claim volume electronically — as much as 70% — Web-based products are now available to support the balance. Some clearinghouses, for example, offer electronic e-processing by collaborating with banks to convert paper documents to 835 data. This process involves scanning paper files, lifting data from images and creating files that can be electronically posted. Digital data can be archived in a repository for several years. This approach provides additional value, like disaster recovery (DR) benefits. Data is secured in an off-site location, protecting it against adversities like fires or hurricanes.
Likewise, electronic remittance advice (ERA) features can drastically reduce processing costs, with fewer people required to post payments, allowing those efforts to be refocused towards managing exceptions. The risk of human error and posting inaccuracies is minimized.
Automated collection of secondary claims is another potential revenue stream that can be profitable for many practices. The average reimbursement for secondary claims across all specialties is $35, a sum greater than most co-payments. With the appropriate Web-based tools, the number of patient statements that need to be dropped to paper can be diminished and staff management time greatly reduced. Because the cost and hassle of secondary filing is minimized, practices no longer need to write off these outstanding balances.
There is little doubt that physician practices are able to improve their bottom lines by adopting technology that facilitates efficient patient eligibility checking, timely electronic claims submission, electronic claims posting and efficient submission of secondary claims. The result? A win-win situation that increases revenue and reduces administrative costs.