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Solutions Supporting a Proactive Revenue Cycle

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Increase revenue and operating margins through a proactive approach enhancing your team's ability to catch and correct errors and identify insurance policies even when they weren't disclosed. 

June 6, 2019


Reactive practices in healthcare are costly. Entire teams are devoted to reacting to mistakes identified long after the patient leaves or a claim has been denied, making it much less likely to obtain the necessary information. The likelihood of getting paid is reduced for each day that passes. Meanwhile, not identifying all available third-party payer sources increase the rate of self-pay and self-pay after insurance, which directly contribute to bad-debt.

Organizations use strategies for a proactive revenue cycle to increase their bottom line by making it easier for patient access teams to collect as much information possible and make sure that information is as accurate as possible. From the business perspective, adopting practices for a proactive revenue cycle represents growth and reduction: Growth in revenue with reduction in overhead.

What is a proactive revenue cycle? 

A proactive revenue cycle is simple using a comprehensive approach for ensuring you get the most revenue possible for the services you provide. It typically involves identifying and correcting errors leading to initial claim denials and identifying all active payer sources available to the patient regardless of the information provided or captured. Being proactive means having this information prior to or soon after a patient arrives for service and before a claim is generated. 

When the entire revenue cycle team embraces the proactive approach, information flows seamlessly. Information coming out of patient access is as clean as it can be and the patient financial service team can focus more time and effort on getting paid. Both teams reach objectives more often, reducing the pressure they feel from always climbing uphill. Revenue grows by reducing denials and identifying more third-party billing opportunities and overhead is reduced as everyone can be more efficient in their work.

How can automation support a proactive revenue cycle strategy?

Any initiative requires an infrastructure to be successful. It will be up to the leadership team to get their team’s buy-in for proactive revenue cycle practices and embed it in to the organization’s culture, but automation services and tools make on-going efforts much more effective. That is why a vital aspect of creating efficiency in your revenue cycles is automating everything possible so your team can focus on high-level tasks.

The best way to achieve a proactive revenue cycle is to leverage automated solutions and tools that address the following main areas:

Discover

Your organization’s top payers should be checked to identify any active coverage that had been missed. In doing so, you find active policies for patients thought to be self-pay and any secondary policies that weren’t previously identified. Your tool should:

  • Check all patients, regardless of insurance status.
  • Connect directly with payers for the most accurate and up-to-date information.
  • Organize information in the easiest to use formats for your teams.

Verify

All patient and policy information needs to be verified for accuracy before or as soon after the patient’s visit possible. Verification should be automated to reduce the need for human intervention and should verify the following:

  • Patient and policy information matches between the provider and payer.
  • Co-pay and deductible amounts.
  • Collect any discrepant information and organize in to easy-to-use formats for your team.

Correct

Once information is verified and additional coverage is found, corrections can be made before information moves through the cycle. To make correcting information easier, your tools should:

  • Create worklists that focus on tasks requiring human intervention.
  • Be distributed to relevant team members so they don’t have to search for it.

Follow-up

When insurance information has been verified, additional coverage found, and corrections have been made, due diligence has been given to everything other than clinical information. At this point, your claim has been submitted and it is time for pro-active follow up so you can respond to anything requiring attention as soon as possible. Your follow-up tool should:

  • Allow for customized rules to align workflows with payer rules.
  • Continuously collect data through the claim’s life-cycle.
  • Automate workflows that move the claim to the next level without human intervention.
  • Create exception lists for issues that can’t be resolved with automation.

Organizations implementing proactive revenue cycle practices have seen significant reduction in denied claims and watched their net revenue grow. This is where services and tools like automated insurance verification, insurance discovery, and retroactive Medicaid monitoring can be useful. Databound offers automated solutions like BOOST − insurance discovery and retroactive monitoring − and CLAIM SCOUT − claim status follow-up − that can help your organization begin moving in this direction.

 

Learn more

Ready to infuse your organization with revenue and make sure you aren’t missing any billing opportunities? Check out our new risk-free tool − BOOST: Backlog Search™ − giving you and your staff a chance to prevent missed billing opportunities.

 

Written by Mike Burhans, MBA, CRCR - Relationship Manager

Mike Burhans, MBA, CRCR - Relationship Manager

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