Over the past six months, I have interviewed over one hundred agency owners asking them specific questions centered around their revenue cycle management.  I wanted to know why this side of the business causes so much anxiety for owners and administrators. What I ultimately wanted to know was if I could provide some guidance to lower that stress….or should I just recommend they increase their blood pressure medicine. 

Here is what I found:  

  • 63% of agencies are not satisfied with their current collections
  • 42% of agencies do not have a back-up plan if their internal biller is to give their notice
  • 35% of agencies have had a bad experience with outsourcing their billing
  • 51% of agencies have not updated their payor rates
  • 44% of agencies are frustrated with their EMR’s billing functionality and reports
  • 84% of agencies reported that vendor response times are unsatisfactory
  • 55% of agencies have a DSO of 75 or older
  • 78% of agencies are concerned with cash flow

The number one concern with all healthcare providers is ensuring their patients receive the highest quality of care, but right after that, is making sure they get paid for providing that care.  With the constant CMS changes, new regulations, and the inability to speak with a human at the payor level when something goes wrong, it’s no wonder healthcare leaders report having high levels of anxiety.  Like a trapped mouse in a maze, lost and confused.  Running here, running there, running everywhere but where in the heck is the victory flag?

This is where I should tell you that all your problems would go away if you outsourced your billing, right?  Nope.  Transferring your pain will not solve your problems, you have just created another number you have to call to get answers.

Revenue Cycle Management is not just billing and collections.  At the fountain of the service, it is about protecting your revenue.  YOU getting paid and keeping it.  That is what it is all about.  That’s right, someone finally said it.

Steps to Uncover the Invisible Truth to Protecting Your Revenue: 

Step 1.  Get your team in a room, no laptops, no cell phones.  Anyone and everyone that plays a role from intake to payment.

Step 2.  What is the data telling you?  No B.S. in this step.  No excuses, no blame.  This is called ownership.  Everyone must be committed to the truth and own their part as to the “why”.  The truth will set you free.

Step 3.  Connect the dots.  Everyone within the agency plays an important role when it comes to getting paid.  Make sure the team knows what part they play and the timeline to execute it.

Step 4.  Create the plan with KPI’s and monitor it week by week.

Common problems I see across the spectrum and a great place to start your meeting.

  1. Payor Set-up & Rate Updates – how were your payors set up and when was the last time you updated your rates?  When was the last time you negotiated your reimbursement with a particular payor? 
  2. Intake – is your intake staff trained to get every piece of information they need for authorizations and eligibility. 
  3. Knowing when the claim is ready for billing – your clinical team and financial team must be in sync.  That was a boy band back in the day.  However, those two departments must come together, and no claim should go unbilled.
  4. Gateway Set-up – make sure that all payors are set up within the clearinghouse to electronically send claims and receive remits.  If the payor cannot be setup, have access to their portal.     
  5. Denials – one out of every five claims are either delayed or denied.  This can create a massive financial strain on an agency.
  6. Rejections – two main reasons for this are (1)duplicated claims and (2) beneficiary eligibility not being verified.
  7. Monitoring Claims – how is the team tracking and following up with claims older than the forecasted payment timeline? With automation of monitoring claims, agencies can know immediately if a claim has not paid within the forecasted amount of time and ping the payor for an update.
  8. Posting Payments & Claim Adjustments – Post every day. Every. Day. Afterall, you have worked so hard to get to this point.  Make sure you are posting claims correctly or you will continue to look at an inaccurate A/R.

If you have tried the 8 steps and you still feel like the hundreds of agencies I have interviewed, it is time to find a reputable, dedicated, and reliable revenue cycle management partner. Be sure to find the one that best fits your needs.  Not all vendors are created equal, but I promise, the right billing partner is out there for you.  Take your time in finding one.  This may be the single most important decision you make this year. The future of your agency may hinge on this decision.