While most executive teams focus planning time on ‘the next big thing’ to position their organizations for the future (see Coming Up With The Next Big Thing and Where’s It Going? The Next Big Thing(s) In Behavioral Health Clinical Informatics), that future is dependent on having a better bottom line for investment. Revenue cycle management is critical to that bottom line to make sure your organization is paid for every eligible service it delivers. Learning how to “beef up” reimbursement was the focus of the “Executive Strategies To Optimize Reimbursement In A Changing Marketplace” session led by Matthew Zabolotny, Netsmart’s Vice President/General Manager of Revenue Cycle Practice during the 2019 OPEN MINDS Executive Leadership Retreat.
How does revenue cycle management help you optimize performance and margins with your current services? It is the process for capturing consumer service revenue, a process that extends from the “first contact” with consumers, such as appointment scheduling and eligibility determination to point-of-service and service authorizations through service coding, billing, and collections (see A Revenue Cycle Management Primer and Have You Mastered These 4 Financial Management Skills For VBR?). Mr. Zabolotny discussed three key elements for ensuring success with service revenue collections: The right people, real-time information for eligibility determinations and service authorizations, and a data-driven approach to managing claims denials.
Right people today, right people tomorrow: No matter what tools provider organizations invest in for revenue cycle management, they all need people who can use those tools effectively and understand the billing and collections process. And, due to high turnover rates for experienced billing team members, Mr. Zabolotny discussed the importance of creative incentive plans and the ability to scale up capacity with contract help when needed. Organizations that want to maximize their investments in revenue cycle management need to start with staffing plans that include better training, incentives, and/or outsourcing.
Eligibility verification and service authorizations in real time: One big factor in improving collections is improving the care authorization process. More than 25% of denied claims stem from authorization issues – making processes for real-time benefit eligibility verification an essential ingredient for success. Mr. Zabolotny also discussed the need to structure (and frequently update) processes and information about the prior authorization process for each payer including benefit coverage and medical necessity documentation requirements.
Data-driven management of claims denials: The key to managing claims denial rates is to prevent claims denials. While a speedy and reactive approach to responding to each denied claim is essential, the ‘big win’ comes with using data to improve the process. Having data to understand which claims are denied and why helps your organization continuously improve its revenue cycle management process.
As provider organization executives look to the future, optimizing revenue cycle management in the here and now can improve margins – and support the resources needed for future growth. For more on improving service revenue collections, check out these resources in the OPEN MINDS Industry Library:
- Three Lessons Learned On The Path To A Sustainable VBR Strategy
- Have You Mastered These 4 Financial Management Skills For VBR?
- What Gets Measured Is What Gets Done: Keys To Selecting Measures For Performance Management
- Report From The Field—Executives Driving Performance Strategies
- Revenue Cycle Management: A New Model For A New Market
- Getting Paid For What You Do
- Six Functions For Moving EHRs To The Next Level
- The Coordination Of Benefits Issue: A Sticky Wicket For Some
- Trickling Cash Flow
- The Essential Tech List For Value-Based Purchasing
Learn more about how tech investments support these efforts with OPEN MINDS Senior Associate David E. Wawrzynek on October 28 at The 2019 OPEN MINDS Technology & Informatics Institute for his session, “How To Implement New Technology Effectively: An OPEN MINDS Seminar On Best Practice Technology Implementation For Maximum Return.”