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Billing Basics: Top 3 Ways to Improve Your

Take a closer look to plug reimbursement leaks

If you think you understand the way your facility's revenue cycle operates, you could be in for a surprise: It's more complex than most hospital staff are aware.

Find out where your efforts fit into the big picture to see how you can improve them in the little one.

1. Know the Key Players
Staff involved in the revenue cycle at profitable, efficient facilities fall into one of four groups, all of which play key roles in the generation of income:
 

Admitting (Patient Access): The folks in the admitting department start the cycle by securing the patient's paperwork, including eligibility verification, certification, registration and scheduling. These staffers also take care of gathering insurance information, collecting the patient's money, and managing notices such as the advance beneficiary notice and HIPAA-related forms.
 

Patient financial services: The responsibilities of patient financial services include creating the bills, handling denials, and collecting payment from patients and insurers. These staff members manage the edits both before billing and afterward, and generally maintain the chargemaster. They also handle appeals for denied claims.
 

Compliance: The compliance staff looks after your facility's legal interests, with expertise in regulatory matters.
 

Finance: These people keep an eye on the facility's big picture, financially. They analyze your case mix, review your patient data and benchmark it, and keep track of your accounts receivable (AR) days (the number of days' worth of patient revenue that you have yet to collect).

2. Put Information - and People - Together
No matter how effective each team of staff members is, all efforts will be wasted unless everyone can work together as an efficient whole.
Don't miss: One step toward this integration is to ensure that when a patient is ready for a scheduled outpatient procedure, his coverage information gets to all the people who need to know about it - including physicians, providers and payers.

"It's important that everyone involved with a patient knows about his coverage," says Jami Gary, RHIA, reimbursement financial analyst at Sun Health Patient Account Services in Arizona and president of the Health Information Management Association of Arizona. Different insurers have different guidelines, so both the facility staff and the patient need to be fully informed, Gary says.
Not only will everyone be up to speed within the facility, but you'll also keep your outside contacts informed, such as third-party payers and lending institutions.
3. Consider New Technologies
Fancy equipment can't save you from staffing or organization problems, but it can make your revenue cycle run more smoothly, from admitting to collection. Also, smart investments in cutting-edge [...]

- Published on 2004-04-16