A thriving healthcare organization relies on the cooperation of many different departments and processes. Regardless of the type of organization you run, successful healthcare revenue cycle management is one of the most crucial components to the health of your workforce.
Revenue cycle management is the overarching combination of claims processing, payment and revenue generation. Simply put, it is the lifecycle of a patient account. In this process, there are many opportunities for pitfalls and errors. Through the assistance of software and recovery management services such as DECO, most of these pain points can be eliminated. At DECO, our mission is to maximize reimbursement to our clients by leveraging innovative technology, processes and compassionate advocates.
Revenue Cycle Steps Explained
In this first step, the patient has made an appointment. At or before this appointment, hospital staff must gather information about the patient and begin compiling a file. Even though it is early in the data collection phase, your organization must decide how to process patients. Making the right choices at this stage is crucial to the steps that come later. While software can store the information gathered, the success of the software ultimately relies on accurate information being entered correctly by trained individuals.
Preauthorization and Eligibility
Preauthorization and eligibility are precursors to medical billing, which is perhaps the most important step in ensuring that your organization gets paid. At this stage, you have collected the needed data from the patient and your team is verifying information with their insurance provider and learning the limits of coverage, including co-payments. The goal is to get the patient pre-approved to perform what is needed. It is important to verify information methodically before getting to the billing stage.
This stage is the one most prone to human error. When claims are submitted improperly, hospital revenue cycle management breaks down across the board, voiding the revenue cycle steps you have already taken and bringing the entire process to an impasse. Improper coding can lead to your organization not being paid.
Payment posting from insurers arrives after claims are accepted, but collecting the patient portions of the bill can be time consuming. Often, payment is never received.
Denial management means taking a close look at denial statistics for your hospital, finding patterns in these denials, and putting the right changes in place to reverse that rate going forward.
Cycle Management Challenges
There are several core challenges that present themselves during the cycle management process. Specifically:
- Declining reimbursement and rising healthcare costs, which means hospitals must try harder to capture every dollar
- Compliance being more complicated than ever
- As revenue cycle management costs increase, payment per claim is decreasing
- There is an increasing need for advanced data and metrics
- Increased reliance on technologies and systems
- Skilled and talented workers are harder than ever to find, hire and retain
For those who do not have insurance and pay on their own, the revenue cycle presents another set of challenges for hospital systems. Self-pay patients tend to accumulate higher medical bills, since they do not have insurance to help offset the cost. A recent study found that 30% of self pay patients generate 80% of a hospital’s self-pay revenue.
Often, self-pay patients cannot afford the out of pocket costs for their treatment. If the information for these patients is not captured before they leave the facility, it can become difficult or impossible to receive payment. Once the information is captured, an eligibility expert, such as those at DECO, can help the facility and patient find a coverage option or payment plan that works for both parties. In turn, this means that more patients are able to find coverage, and more hospitals are able to be paid.
Components of Successful Healthcare Revenue Cycle Management
In the hospital revenue cycle management process, it is important to make sure the proper vehicles and channels for payment are used. A program like DECO Recovery Management Services can prove to be an invaluable asset in both the lives of recipients of medical assistance and in the financial aspects of hospitals and other related facilities.
In our system, every self-paying patient is tested for Medicaid eligibility. These patients then become insured patients, meaning that the hospital gains a definite form of payment in an instance where they may have never been paid at all. We are also able to provide help to those with disabilities. DECO provides access to transportation and resources that these individuals may not realize they qualify for.
Our experienced, bilingual consultants and navigators are well-versed in hospital administration protocols and Medicare/Medicaid/SSDI claims procedures. Our staff quickly becomes a part of your facility’s revenue cycle team.
DECO has developed a proprietary, in-house designed Eligibility Management software, called DECOnet. This program has been specifically designed to promote tasking, tracking and reporting both eligibility and disability statuses. DECOnet works seamlessly with most hospital systems.
When the window to capture information is vital, you don’t want to miss anything. Our 94% capture rate means that you get paid for the services you provide, and don’t have to use valuable resources to make it happen.
If you are interested in getting started with DECO, contact us today.