Touching nearly every aspect of your operations, flawed revenue cycle management can be damaging to your agency. It’s important to regularly perform a revenue cycle review, particularly if there have been recent regulatory updates that change how you get paid (PDGM anyone?).
Here are some things our experts say you should look at during your revenue cycle review.
Clinical Documentation Accuracy
One of the best ways to protect your agency from denials and ensure regulatory compliance is to take a close look at your clinical documentation. Look for common patterns or trends – often that means that nurses are documenting based on what is “usually done” when it comes to a particular diagnosis, and not necessarily what should be documented to truly reflect what was provided to the patient.
Have you established documentation guidelines designed to help your clinicians assess and document to the best of their abilities? Does your clinical documentation clearly paint a picture of the patient’s problems, goals, and interventions?
Accurate coding is at the forefront of optimizing reimbursements. During your review, it’s important to identify weaknesses like slow turnaround, excessive errors, or over/under coding. Then determine how to address these problems.
Have you seen a decline in coding accuracy since ICD-10 and PDGM rolled out? Does your coding team spend an exorbitant amount of time on coding? Perhaps they need more training, maybe they don’t have enough time to code accurately, or don’t have the experience to meet the necessary demands.
Timely billing is incredibly important to maintaining cash flow. When reviewing your billing processes, it’s important to take a close look at where cash flow is held up and why. Identify hiccups in your workflow that could be causing a slowdown or costly errors.
Ask yourself, are you leaving A/R unattended? Are rejected claims being managed? What is your clean claims rate? Once you identify areas that require focus, it’s important to quickly resolve problems and put processes in place to avoid repeats in the future.
From intake all the way through billing, each team member can influence your revenue cycle operations. Active participation and communication between all disciplines is imperative. Do you schedule weekly meetings to facilitate good communication? Have you set up workflows that lend to regular, open dialogue about your revenue cycle management? Do you have processes set up to keep everyone on track and well informed on priorities and tasks?