7 Ways to Enhance Your Radiology Group's Revenue Cycle

Transcription

1 7 Ways to Enhance Your Radiology Group's Revenue Cycle

2 Introduction Every radiologist would prefer to be reading charts than spend time thinking about their practice s revenue cycle management processes. Radiology practices whose billing processes are not optimized will be less financially healthy and profitable than their counterparts. In order to enhance your practice s financial health and ensure its prosperity, then, you need to select the right revenue cycle management tools and practices. Effective revenue cycle management involves more than just reforming the billing process. The complexity of the revenue cycle means that, any practice that wants to engage in revenue cycle management will need to address multiple challenges. This ebook will address seven ways that you can improve your radiology practice s revenue cycle management practices.

3 Table of Contents One: Improve Your Charge Capture 4 Two: Participate in the Future of Coding 5 Three: Don t Sacrifice Accuracy 6 Four: Strive for Quality 7 Five: Speed-Up Your Claims Submissions Process 8 Six: Improve your A/R Management 9 Seven: Enhance Your Collections Capabilities: 10 Conclusion 11

4 1 Improve Your Charge Capture A radiology practice, no matter how prosperous and no matter how seemingly successful, can t afford to lose profits on uncollected bills and lost reimbursements. For that reason, if a radiology practice is to be successful and if it is to achieve its financial goals, it must institute a series of practices that will enable it to capture all charges or look for a revenue cycle management provider who can do this. Doing this will ensure that a practice will be able to document all of its procedures and account for all of its revenue. It must implement automated manifest reconciliation processes, devise comprehensive variance lists, which include both the practice s CDM coding and the physician s document and, finally, must include information about both retrospective and prospective audits and charges by modality. As a practice owner, you can seek out a firm who is able to implement these practices and tools. Once they are fully operational, these your practice will likely be more profitable. 4 7 Ways to Enhance Your Radiology Group s Revenue Cycle

5 2 Participate in the Future of Coding All practices will be transitioning from ICD-9 codes to ICD-10 codes. These new codes are likely to be more demanding than their predecessors and will require practices to have a better understanding of both their current and their projected patient volumes. These new coding mandates sound like they might be costly and might upset your practice s revenue collection management plans. New codes will only pose a problem for your practice if you are unprepared for them. Thankfully, if your practice partners with experts who are prepared for impending changes, it will be able to weather the storm brought on by new codes. Your practice needs to make sure that every one of its studies is read by a certified coder. Taking this step will ensure that your revenue cycle management aims are met. 5 7 Ways to Enhance Your Radiology Group s Revenue Cycle

6 3 Don t Sacrifice Accuracy It s important to never sacrifice accuracy in an effort to speed up the claims submission process. A reputable revenue cycle management partner understands that, while it is important that your practice s claims submission processes be as efficient as possible, it is equally important that they be accurate. For this reason, as a part of your claims submission process, they should incorporate system scrub codes that are based on payer guidelines and Dx rules into your system. Applying best practices, when inputting accurate registration and billing information is critical, as is posting a charge with the appropriate: 1 Diagnosis code 2 CPT Service code Making your claim submission process a more accurate one will speed up the billing process and make sure that you are properly reimbursed in a timely fashion. 6 7 Ways to Enhance Your Radiology Group s Revenue Cycle

7 4 Strive for Quality Perhaps the most important part of an effective revenue cycle management plan is to ensure that the data collected and transmitted is of the highest possible quality. Data that is free of errors can be more quickly processed, which could translate into quicker reimbursements for you. To make sure that the claims being submitted are of the highest possible level, your revenue cycle management firm should have have 5% of your daily pulled and audited, and engaged in both front and backend audits. 7 7 Ways to Enhance Your Radiology Group s Revenue Cycle

8 5 Speed-Up Your Claims Submission Process In addition to improving your charge capture, you will need to make your claims submission process a leaner and more efficient one. You will need to make sure that, whoever is tasked with managing the claims submission process, is capable of undertaking speedy, error free claims postings. Doing so will ensure that you receive reimbursements more quickly. This is an essential part of any revenue cycle management process. 8 7 Ways to Enhance Your Radiology Group s Revenue Cycle

9 6 Improve Your A/R Management It sounds intuitive, but a lot of practices ignore this essential part of the revenue cycle management process. The revenue cycle management firm that you partner with must implement aggressive denial management and prevention measures, as well as reimbursement tracking tools. While this will go a long way in making your A/R management practices more efficient and profitable, they will also need to analyze these processes and ensure that they are operating at peak efficiency. Make sure that whoever is tasked with managing your A/R assigns a dedicated representative to analyze your accounts information and put in place a review schedule, that is designed to measure payer contract compliance. In addition, your accounts-receivable team should compare year-to-date totals, as compared to those in the previous year. They should also make sure that any accounts-receivable that are older than 60 days are carefully detailed and followed. 9 7 Ways to Enhance Your Radiology Group s Revenue Cycle

10 7 Enhance Your Collections Capabilities With the increasing number of high deductible insurance plans, and a growing number of self-pay patients, the focus on outstanding balances is greater than ever. If you are going to maximize the revenue you collect and make your practice more profitable you must put a team in place that is dedicated to collecting outstanding bills and charges. While most practices use practice management systems, there are other practices and techniques that will enable you to collect your outstanding bills. You need a team that has: A process in place to appeal underpaid claims and recover reimbursements Note: This should include software that notifies them about payments that are under or over payer fee schedules Automated call software Denial tracking, aggressive management and reporting Finally, your collections team must pursue small balances. Though this may seem counterintuitive, this step augments any revenue cycle management strategy Ways to Enhance Your Radiology Group s Revenue Cycle

11 Conclusion Of course, each radiology practice will require different methods, tools and practices to optimize their revenue cycle management practices. It s essential, however, that you acknowledge the need to engage in best practices that extend beyond simple adjustments to billing. As discussed in this ebook, to be effective at revenue cycle management, a radiology practice needs to comprehensively reform its: Billing Claims submission Coding processes Have additional questions? HIS can help. See the next page for details Ways to Enhance Your Radiology Group s Revenue Cycle

12 About Us HIS is committed to being the leading provider of revenue cycle management solutions and information technology services. We combine real-world industry experience with in-depth technical expertise to achieve practical solutions that deliver return on your investment. We focus beyond reimbursement in order to optimize your bottom line and profitability and we are uniquely dedicated to helping radiology practices like yours successfully grow faster and create measurable value for you and your partners. At HIS we greatly value the enduring relationships we've built with our clients since first opening our doors more than two decades ago. We have sustained these working relationships by having the ability to provide seasoned business advice that our clients respect and value. What You Can Expect from HIS: Improved Efficiency of Coding: With HIS we provide an enhanced understanding of coding guidelines. With 30+ years of experience, HIS' staff of 225 professionals, including over 65 certified coders, understand the most complex management systems and clinical issues. Every study report is read by a certified-coder to ensure that all charges are being captured. Customized Coding Education Program: Our Radiology Division develops a customized coding education program that is tailored to your needs. We meet with you to access and audit your dictation to help ensure maximum allowable reimbursement Excellent Charge Capture: At HIS we provide you automated manifest reconciliation to help you increase your reimbursements. We accomplish this with variance lists (hospital CDM coding vs. MD documentation and prospective & retrospective audits by modality. Clean Claims and Increased Submission Rate: HIS can increase your reimbursements is with clean claims. Our system scrubs codes according to payor guidelines and Dx rules achieving lower back-end denial rates. We can increase the speed of your claims submission with error free, fast charge posting, and eliminate delays due to unforeseen staffing issues within your clinic. The bottom line is: Faster TAT = quicker reimbursement. 350 S. Northwest Highway, Suite 200 Park Ridge, Illinois (855) RING-HIS (847) Fax: (888)

13 Sources 1. Management Revenue%20cycle%20mgmt-a%20life%20cycle %20approach%20for%20perf%20measurement%20and%20syst%20justification-HIMSS_2010.pdf 5. %20Preparing%20for%20Near-Term%20Change.pdf Images All photos courtesy of: freedigitalphotos.net