For financial healthcare executives, optimizing cash collections since the pandemic is a focus area. EMS calls have dropped 26 percent nationwide in U.S since the start of the pandemic1. Now is the time to take an introspective review of your overall processes ensuring there are no leakages.
What is Revenue Leakage?
Lost opportunity to collect money for the cost of goods and services being billed and collected by various payer entities. Typically, the loss of this revenue goes unnoticed and mismanaged; therefore, leading to negative outcomes and poor client satisfaction.
Top Ten Areas to Review to Prevent Leakage:
- Dispatch System Reconciliation- When was the last time you reviewed your interface and mapping with your client? Units and priority codes are ever changing. These discrepancies can lead to incorrect billing scenarios and trigger audits. Ensure you have a solid reconciliation process accounting for all billable services between platforms.
- Authorizations- Do you have a call clearing, online ordering service established for transports that require authorizations? Does your client know the payers that require an authorization before the ambulance leaves the barn? A collaborative effort should be in place ensuring all payer requirements are fully being captured. Every missed authorization is a missed opportunity that will impact your profitability. Utilize your billing system for payer requirement ensure processes are not outdated.
- Eligibility- Utilizing appropriate eligibility tools is essential for maximizing collections. Having a third-party vendor to assist in auto eligibility and automation is key. Ensuring your billers are well versed in the payer requirements and timely filing are pertinent to prevent leakage. Poor eligibility practice can lead to billing errors, increased denials and ultimately write-offs.
- Automation vs. Manual Billing- Does your billing system have the sophistication, ability for growth, and automation to support your billing users and clients? The ability to be progressive and strategic create opportunities for expanded business growth. Manual billing accounts for 15 percent of errors resulting in lost revenue.
- Credentialing & Enrollment- Are you and your client properly enrolled with your federal payers? Making updates to the application process can take several months for consideration. This can result in cash bottlenecks possibly resulting in write-offs. Getting ahead of the mark is essential for consistent cash flow.
- Payer Contract Issues- We all have them, evergreen contracts that continue to renew year over year. When was the last time these contracts were reviewed for outdated contract language, unrealistic objectives, pricing along with unreasonable payment terms? Reviewing contract terms, fee schedules, and profitability with clients ensuring expectations are clear and concise.
- Poor Denial Management- Did you know that most denials are preventable or avoidable? First you need to understand the type of denials you are receiving. Look for root cause analysis refer to payor website for coverage updates. Track and trend denials to ensure information is being shared with all respective parties. Look for opportunities to train a subset of users to make them your “experts” in appealing and overturning your denials.
- Lack of Transparency– Lack of reporting can send an organization into a tail spin. Taking the time to ensure the proper reporting dashboards are all intact.
Real-time monitoring is imperative for any billing platform. Communicating and understanding trends are vital to the success for both you and the client. Do not rely on manual tracking mechanisms, optimize visibility on every level. - Short Pays & Write-offs- Do you have the confidence that your largest payers are reimbursing for every dollar due? Insurance companies have hiccups and system issues that will reflect inaccurate payments. Is your system setup to capture these partial payments or are they being written-off? Ensure that you have a mechanism to capture these payment variables and the ability to correct the process.
- Quality Assurance (QA) Process- Does your organization have a QA program? QA is essential for every revenue cycle organization. Audits should be performed regularly on variances trends to ensure compliance and efficiency. The absence of a QA program may result in loss of revenue through payer audits, offsets, and prepayment reviews. Look for training opportunities internally and externally on focus areas that will enhance the quality of the revenue cycle.
The staff at Integra Connect are tenured and well versed in identifying ‘revenue leakages’ while offering strategic solutions to improve the overall business model. The team has vast experience and knowledge base in both federal and state billing requirements. We provide billing services for nearly all fifty states and know how to navigate the many different landscapes across the country.
We can help you with this navigation and be a partner and advocate for you. Do not hesitate to contact us to see how we can help you with ensuring you are following the guidelines in your state and what options you have as a provider.
Sources:
1University at Buffalo. “EMS calls have dropped 26 percent nationwide in U.S. since the start of the pandemic.” ScienceDaily. ScienceDaily, 26 June 2020. <www.sciencedaily.com/releases/2020/06/200626092735.htm>.