The reality post-COVID requires new strategies.
The COVID-19 pandemic put many practices in financial distress because of dropping patient volumes, but poor revenue cycle management practices exacerbated the problem. These challenges illustrate how RCM must be quick and efficient for a practice to survive and thrive.
Matt Seefeld, executive vice president and head of revenue cycle for MedEvolve, spoke at the Medical Group Management Association Medical Practice Excellence Pathways Conference about what every practice needs to be doing to master its RCM.
Here are the keys:
All patients should have their insurance verified, and all referral and authorization requirements should be confirmed. Patient liability needs to be calculated and projected balances or prior balances should be collected.
Patients need to be aware of their financial responsibility using dashboards and reminders. Identify the number self-pay patients scheduled in a month and prioritize collections up front. Providers must commit to collecting missed payments before a patient can schedule a new appointment.
Not everyone has the personality necessary to speak to a patient about their financial responsibilities. Monitor staff productivity and identify strengths and weaknesses and know the results each team member produces. Provide additional training where necessary.
Practices are collecting less patient pay due to HDHPs, and COVID-related issues, such as reduced patient volumes and unemployment. MedEvolve’s data shows a jump in self-pay balances in early 2021: September $1.5 million to February $4 million. Practices are only collecting an average of $18 per visit, with 77% of AR over 60 days, and 35% increase in patient debt.
• price transparency
• to clearly understand their benefits upfront
• to know financial responsibility (no surprise billing)
•flexible payment options (over the phone, online, mobile) and payment plans
Staff must be given the knowledge to address these needs and better engage patient directly.
Communicate via the patient’s preferred method (email, phone, text) Boost patient satisfaction by speaking to them through channels they prefer
Text and email communication increases your connect ratePersonalize communications based on demographics Track your interactions to help measure effectivenessReduce dependence on statements: paper statements are expensive and increasingly less effective
Collect email addresses and cell phone numbers while checking demographics during financial clearance
To keep key employees, work-from-home options may need to be permanent, but this requires boosting communication within the RCM team.
With a virtual workforce, it’s important to be able to track communications and manage tasks to ensure the work is getting done, who is responsible for what, and ideally all the communications will be logged on the patient’s record within the payment system. The system should assign tasks to other department or representatives when assistance or additional information is required.
Advanced analytics tools can differentiate between total A/R and the actual value— including denials, past due patient balances, claims that have yet to be filed, and partial pays.
•Identify new cash opportunities, root cause issues and measure effectiveness of process changes
•Administrative teams will need to extract deeper insights from their data to inform financial forecasting.
The more real-time data, the quicker you can react. Waiting until the end of the month to study spreadsheets is no longer an option.
Net Collection Rate and what is due from insurance vs. patient
Liquidity of your AR and when you are going to get paidThe status of your current AR and the actions your staff are taking Effectiveness of your RCM partner
Avoidable write offs and what to do to prevent themWhat patients are financially cleared or at risk prior to serviceForecasting impact to net revenue with subtle changes in payer and procedure mix and patient volumes
Workflow automation in your RCM process can:
Streamline revenue cycle efficiencies while maintaining a lean organization
Prioritize workflows around the greatest return on investmentMonitor staff productivity and effectiveness
Allow you to know exactly where every dollar in AR is at all times
• Reposition and restructure staff for a healthier bottom line
•Gain greater visibility into and control over revenue cycle processes and staff productivity
• Focus on the right claims at the right time
• Increase productivity, without adding FTEs
• Balance staff workloads
• Employees spend time on a fraction of the claims (80 to 90% of claims in AR do not require attention each day)
•Improve morale and accountability: staff feel empowered with smarter and more structured workflows to guide their activities.