Advanced Revenue Cycle Analytics: An Overview

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The revenue cycle is the backbone of your practice. Without a healthy revenue cycle, you won’t get paid, and your practice will collapse. It’s important to be on the lookout for potential threats that could hinder your cash flow. Below are five revenue cycle threats we have identified as well as solutions to help avoid them.

Threat: Increased High-Deductible Patient Plans

High-deductible insurance plans for patients are on the rise. 43.2% of adults have high deductible insurance plans, and 9% are uninsured. As a result, more of the financial responsibility for healthcare falls on patients. Collecting from patients can be awkward and difficult. The key to avoiding this threat is to ensure that you check their insurance eligibility before the appointment. Be sure to ask what method they will be using for payment, and collect before they receive care.

Solution: Be diligent about checking insurance eligibility before the patient appointment.

Threat: Lack of Follow-Up on Claim Denials

Claim denials are a huge threat to your revenue cycle. Not only does it slow down your cash flow, but many denied claims never get resubmitted. That is revenue down the drain, and it should never happen. It costs $25 to resubmit a claim, but the cost of ignoring that denied claim is greater. Hire someone in your practice to stay on top of denials. Trace down the cause of every denial to make sure that it doesn’t happen again, and take the time to resubmit every denied claim. It’s worth it.

Solution: Implement a closed-loop denial management system.

Threat: Coder Turnover

The market for hiring good coders is highly competitive right now. Coder turnover is high, so if your revenue cycle depends on the industry knowledge of one really good coder, losing that coder would be detrimental to your revenue cycle. To make sure that this threat doesn’t affect your practice, invest in technology that will back up your coder’s expertise. Use a rules-based software like AccelaSMART to build rules for the coding changes your coders make most often. Not only will this increase coder productivity, but it will protect you if they decide to leave tomorrow.

Solution: Back up your coder knowledge with rules-based technology.

Threat: Value-Based Reimbursements

We have seen many clients experience an increase in denials due to the shift towards value-based reimbursements. Certain insurers are demanding more detailed coding to prove medical necessity. If you are experiencing these types of denials, it is best to adjust to the demands of the payers. Ultimately, the trend is heading towards value-based reimbursement across the board, and it is best to shift your coding standards to match it.

Solution: Adjust coding methods based on insurer demands.

Threat: Lack of Insight into Revenue Cycle

Many revenue cycle managers want to improve their revenue cycle productivity and outcomes, but they don’t know how. Without actionable data to see what is happening within your revenue cycle, you can’t make real improvements. What revenue cycle managers need is Advanced Revenue Cycle Analytics. They need to be able to see how many encounters their coders can review in an hour, and which coders perform better than others. What changes are they making the most often? These are the types of data that can help you make real improvements to your revenue cycle outcomes.

Solution: Use Advanced Revenue Cycle Analytics to make improvements to your revenue cycle.

Want to know more about how White Plume can partner with you to produce real outcomes in your revenue cycle? Schedule a quick and easy demo today!