A new year means new complications for the Healthcare Revenue Cycle. A new report from Crowe, a public accounting, consulting and technology firm explores the potential risks for healthcare in 2019. This report came from reviewing risk assessments in 2018 for more than 250 hospitals, physician practices and other providers.
Billing and Collections
Many practices are outsourcing their billing and collections. This is a great option for many organizations to reduce overhead and improve their revenue cycle. However, it is important to obtain monthly reports from your billing agency and pay attention to rejection and denial rates to ensure your revenue cycle is being managed appropriately.
This area focuses not as much on how to capture the charges as much of this is done via most practice’s EHR’s. The focus here is more so to do with the Charge Master. Make sure your charge master is up to date and that you are charging more than your max reimbursement amount from your list of payor’s fee schedules. If you haven’t done a chargemaster review in over a year, it may be time to have someone come in and help you do a review.
Providers need to ensure that their documentation not only supports the services being billed but the ICD-10 codes that are being used as the assigned diagnosis codes for the services. ICD-10 has specific requirements about the order of codes and the specificity. It is a good idea to review your top utilized diagnosis codes to ensure they are being used correctly.
Ensure your practice or organization has a documented policy and procedure for dealing with denials. There should be a way to do effective reporting to recognize top denials, as well as a team in place to exhaust all efforts on denials the first time to avoid re-working claims multiple times.
From scheduling to financial counseling, practices should be certain they have the right staff in place to obtain all the necessary information from patients and obtain payment prior to the patient seeing the providers. Detailed demographic information should be obtained prior to visit, including any primary, secondary and tertiary insurances, as well as subscriber information. Staff should be trained in financial counseling for patients with high deductibles or no insurance. Be prepared with self-pay fee schedules, payment plans or financial hardship processes.
These are a few of the areas identified by Crowe that are high-risk for 2019. For the full report, click here.