Are You Leaving Millions on the Table? 3 Opportunities to Maximize Revenue
A well-managed revenue cycle is the key to a hospital’s financial success. But how do you know that your revenue cycle management strategy is working for you and not against you? Many hospitals aren’t capitalizing on opportunities that already exist in the revenue cycle, leaving millions on the table. And while any time is a great time to uncover lost revenue potential, in today’s economy you can’t afford not to.
The good news? There are untapped dollars within your revenue cycle that you have already earned and you’re likely overlooking opportunities to increase net patient revenue.
Preventable Errors are Costing You Time and Money
According to the Centers for Medicare and Medicaid Services, 30% of claims are either denied, lost or ignored. Hospitals are losing revenue every day to preventable errors, and they’re wasting unnecessary resources on back-end claims adjustments, rework and appeals. Further, many hospitals are missing opportunities to ask for patient payment and submitting claims that should never have been filed.
Mistakes that occur on the front-end, whether that’s errors in patient data quality, eligibility or authorizations, often go undetected and make their way to billing. The result? Denied claims and additional rework for your staff, all of which are chipping away at your bottom line. Sure, you can address these errors on the back end, but at what cost? Your answer to cost savings lies in your front-end processes, not in back-end cleanup.
Take a Deep Dive into Your “8s”
Chances are, you’re not even sure what types of denials are costing you the most. Before you can think strategically about a corrective action plan, you need a deep dive into your claim and remit data—and you might be surprised by what you see.
A review of your 837/835 claims and remit data (your “8s” data) will reveal reoccurring themes—the common errors and recurring denials that are draining valuable time and resources. Identifying your denial patterns sets the stage for prevention. Combined with the right front-end revenue cycle solutions, this exercise serves as the launching pad for denial prevention, cost savings and improved staff efficiency. The bottom line: if it’s recurring, it’s predictable and preventable.
3 Opportunities to Maximize Revenue
1. Denials and Rework
Patient payment is a prime opportunity for financial gain, but chances are, you’re losing a significant amount of that money to back-end collections and writing off as bad debt. Add to that errors in registration, eligibility or prior authorization and you’re stacking the denial pile and loading up your staff with unnecessary rework. Studies have shown the average cost to rework a claim is at least $25.00 and as high as $100+! Multiply this by thousands of preventable denials, and you’re only compounding your loss.
Your claims and remit data analysis will reveal two important things about your revenue cycle: the recurring denial patterns costing you the most and if your current RCM is doing enough to protect you from denials. Leading revenue cycle departments expect their RCM partner to conduct a pattern analysis to identify recurring, denial-causing issues, and then use that analysis to optimize their technology for denial prevention.
2. Patient Responsibility
While pre-service is your best chance for collecting 100% of the patient dollar, it’s often an afterthought for hospitals. Collecting just the copay might be routine for your hospital, but it’s not helping your bottom line. Engaging your patients in financial conversations early in the revenue cycle will help you collect more up front, but only if you can tell patients how much they owe. Allowing your staff to calculate and provide an accurate, patient out-of-pocket cost estimation, complete with prompts and scripting to effectively communicate to the patient, will empower them to initiate the discussion around patient responsibility and your patients will feel well informed and less anxious about the cost of their care. Add front-end communications for patient procedure reminders and offers for flexible payment, and you further increase pre-service collections and patient satisfaction.
3. Authorizations
Failure to secure prior authorization for certain procedures can result in claims denials and a delay in care for your patients. Analysis of your 8s data will pinpoint the doctors who regularly backlog your system with authorization denials. AccuReg utilizes this analysis to create intelligent rules to flag these “repeat offenders” and alert your staff to get the proper authorization prior to service. Our tech-enabled prior authorization services save you valuable time and resources by initiating, submitting and retrieving authorization determination for all payers and all services.
Optimize Your Revenue Cycle to Stop Revenue Loss
Opportunities to maximize revenue are there if you invest in the front-end solutions that detect and alert you to the errors that result in costly denials and rework. Denials prevention—not management—is the key to reducing back-end costs and getting the most cash-in-hand when it costs the least.
AccuReg’s market-leading patient access solutions, ranked number one by Black Book Research the past 3 consecutive years, automate critical functions in user workflows and deploy real-time alerts to help your staff avoid costly errors in registration quality assurance, eligibility verification and benefit validation, patient estimation and prior authorization. Reporting tools give management visibility into error reporting and resolution, which creates accountability for your staff and sets the framework for establishing benchmarks for denial prevention.
To learn more about the untapped potential within your revenue cycle, watch our on-demand webinar, Stop Revenue Loss Dead. Recover Millions You Already Earned.