They’re the most common errors we’ve seen when performing our comprehensive revenue cycle analysis, the Revenue Cycle Performance Review (RCPR), across more than 80 hospitals. In fact, even when hospitals reported that they follow these principles, data-driven analytics proved that was not the case.
- Electronic submission. Your business office should be submitting more than 90% of primary claims electronically. Submitting paper claims is inefficient, more costly, and can cause delays in payment. High-performing hospitals audit these numbers every six months.
- Clean claims. If you don’t have a quality claims scrubber with appropriate front-end edits, the resulting low clean claim rate will require your staff to manually process more claims. Ideally you should be evaluating your claims rate and auditing the edits regularly.
- Discharged Not Final Billed. You shouldn’t let gross days in DNFB be greater than 3 to 5 days. If they are, you should perform a process-oriented root cause analysis to identify which departments—HIM, business office, etc.—are increasing DNFB days.
- High-dollar claim monitoring. It’s critical that you monitor and report on the weekly status of high-dollar claims that comprise the top 10% of your total A/R.
- Worker queues. One of the best ways to efficiently manage your team is to have an online receivables workstation or collector queue to ensure the workload is appropriately and strategically distributed. Worker queues can be routed based on the strengths of your team or on vendor-specific accounts: denials, aging buckets, government receivables, etc. This technique prevents backlogs, ensures timely follow up, mitigates increases in A/R, and prevents an A/R aging problem. These programs also provide real-time transparency via robust reporting capabilities to show the health of your A/R and offer greater visibility than a typical patient accounting system.
We’re all looking for ways to lower operating costs and increase capital, and the investments you make in your processes are just as important as the investments you make in your technology. Executing some or all of this list can yield large amounts of incremental capital.
And this means increased margin, which is becoming more important as reimbursement shrinks and as the financial burden shifts from insurers to patients.