Guide to Revenue Cycle Automation
Posted on May 17, 2022 by Kylene Ordway
While many patients are surprised by the sticker price of healthcare, they should also be shocked by the administrative costs created in a healthcare revenue cycle. The Journal of the American Medical Association (JAMA) published a study that found that the average cost of insurance claim processing and billing for a single primary care provider is $99,000.
The study found that even with computerized billing, it takes 13 minutes and $20.49 to process the bill for a primary care visit. The time and cost shoot up to 32 minutes and $61.54 for emergency room care and discharge. And if your practice offers inpatient surgical procedures, it takes a whopping 100 minutes and $215.10 to complete the claims and billing tasks.
About the Revenue Cycle
Third-party payment programs might make health insurance more affordable and increase access to healthcare services. However, they complicate the billing process. Just in Ohio, individuals have access to over 14 private insurance companies, with countless plans, deductibles, and co-pay variations. Even if you work with just a fraction of those insurance carriers, your front and back office teams have to deal with an incredible volume of variables while also providing top notch service to patients who expect them to know the ins and outs of their insurance coverage, co-pays, and deductibles.
Your team must complete various steps to ensure the correct data is collected and verified, submit claims, and manage billing. There are at least seven steps to be completed for each patient visit.
Your front office team collects patient demographics, insurance details, and eligibility through a clearinghouse while the patient is on the phone. They learn about the patient’s coverage, deductibles, co-insurance, co-payments, and if a referral is required. This is a perfect time to talk to the patient about their financial responsibilities, including time of payment and cancellation policies. Setting these expectations in advance can reduce payment questions or disputes later.
Your team confirms the patient’s information is accurate. They also collect co-pays and ensure any necessary referrals or authorizations are complete. The front office team completes this step every time a patient receives treatment.
3. Charge capture
Your medical coding specialist (or team) enters the services and charges and pulls the details from the provider’s documentation. This information moves to billing.
4. Claim submission
Your team sends the patient and charge information to the insurance carrier. Claim scrubbing ensures the claims are clean, accurate, and transmitted correctly. They should receive a transmission report including claims sent, claims coming back in, and claims dropped. The transmission report also includes a rejections report, identifying incorrect codes. Your team should review these reports to identify and rectify errors so claims can be processed and paid.
5. Remittance processing
Remittances include the explanation of benefits that determine allowables and what the insurance company will pay for each service. Your fee schedules are another element of the remittance process. These details are critical to accurate accounts receivable processing.
6. Insurance follow-up
Your team reviews what has and hasn’t been paid and follows up with the insurance companies as needed. They can run an accounts receivable report to show all charges that have been with the insurance carrier or the patient.
7. Patient collections
The best time to collect payments from patients is when they’re in your office. You should aim to collect any known co-payments and deductibles at the time of service. You also need a standard and a clearly communicated policy for patient payments.
While the costs to the patient may not always be clear at the point of service, you also need to ensure the timely issue of patient statements. When your team has the necessary information and can set financial expectations from the very first patient interaction, you have a much higher chance of timely patient payments.
Creating efficiencies in the revenue cycle with automation
That’s a lot to do manually. With so many steps and details, manual revenue cycle management can be rife with errors and delays. It creates an unnecessary burden on your team and can detract from the patient’s experience.
Revenue cycle automation can streamline these processes, freeing up your office staff so they can focus their energies on more important tasks.
About Revenue Cycle Automation
While the revenue cycle has been computerized for some time now, many medical practices still have a team of people who complete each step manually. You can implement a program to:
- Expedite cost estimates
- Automate benefits retrieval
- Assist or submit preauthorizations
- Reduce manual data entry
- Automate claim denials
- Improve integration between third-party tools
Automating these steps with the right software creates efficiencies that save you time and money. Ultimately, when you reduce time-stealing tasks, your providers and office staff can focus on what really matters — the patients. Revenue cycle automation can enhance patient communications opportunities and the overall patient experience.
Laura Lay, Senior Director Revenue Cycle at Fisher-Titus Medical Center, suggests finding automation that works for your organization. Not all healthcare providers are the same, so what works for larger health systems will not always meet the need of smaller, rural health systems.
Benefits of Revenue Cycle Automation
Ms. Lay believes revenue cycle automation is vital because it allows staff to improve productivity, drives in cash in a timely manner, and provides positive patient experiences. In addition, revenue cycle automation offers the following benefits:
As mentioned, submitting claims, following up with insurance companies, and managing patient billing are all time-consuming tasks. The right program can complete tasks in seconds that a human would need minutes or even hours to finish. According to a recent article on Healthcare Finance News, process automation is equal to about 27,000 hours in a month.
Many people think that automation leads to job losses and a reduction in full-time employees. However, if your practice is thriving and growing, revenue cycle automation allows you to take care of your existing employees and make the most of their skills instead of hiring new office staff to keep up with increasing volumes. You save money by not having to hire as many new office employees to keep up with your needs.
Improved employee engagement
An added benefit of training your existing employees and helping them develop professionally is increased employee engagement. Engaged employees are invested in the practice and care about its success and growth. It is not simply a job or a means to an end. Happy employees provide better patient service.
Fostering a healthcare culture and improving the patient experience
Another benefit of revenue cycle automation is that you and your team have the time and motivation to create and foster a patient-focused healthcare culture. As mentioned, happy employees provide better patient service. When patients are satisfied, they continue to use your service, and tell their friends and family about how much they love their doctor or practice, bringing more patients through your doors.
How to Get Started
If you’re ready to invest in revenue cycle automation, you need to do a little preparation to make sure that you choose the product that best serves your practice’s needs. Ms. Lay emphasizes “best fit” for your unique healthcare niche, selecting the right vendor, and having a successful and collaborative relationship with them.
Review existing processes
First, review your existing processes and break them down to the most granular level to understand where automation can have the greatest effect. This review can also refresh you on the nuances of the revenue cycle, which is critical when choosing the right software or partner to meet your needs. For example, there are opportunities to automate:
- Front end processes
- Medical coding
- Accounts receivable and denial management
You should also review any existing workflows and knowledge management systems for data about repetitive tasks and other non-value activities. Make sure to consult your front office staff as well as the providers to collect information about how they use existing systems and where the day-to-day issues occur.
Carefully research and select your platform and service provider
When you complete your review, then it’s time to start investigating potential service providers. There are plenty of start-ups that offer healthcare revenue cycle automation software. Consider the software, licenses, and the support available.
If you’re looking for more than software, consider companies like KeyBridge Medical Revenue Care. This family-owned business only serves the healthcare industry and has helped their clients with revenue cycle support to automate processes, clean up legacy accounts receivable, open bottlenecks, and clear unprocessed denied claims. KeyBridge Medical Revenue Care integrates well with most electronic health records and other medical office management programs.
KeyBridge Medical Revenue Care offers patient-focused collection services and Master Classes on creating a healthcare culture in your practice, which has wide-reaching benefits for your team and patients.
Implement the platform
Introducing new software always creates a certain amount of growing pains. However, with a company that provides a strong onboarding program and hands-on support, you can help your team learn the new platform and realize the benefits and efficiencies quickly.
Take time to check in with the office team and providers to make sure they’ve received any necessary training and are gaining confidence with the new system. If you learn of any consistent issues across the teams using the platform, reach out to your service provider for additional training and assistance.
Automating the revenue cycle can create efficiencies that not only save your business money, but can also improve the experiences of your employees and patients. If you haven’t looked into revenue cycle automation, it’s time to review your existing processes and ask your team what could be better.
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