Six Guidelines for Achieving Operational Excellence in Difficult Times

1. Automate Eligibility and Coverage Processes
The majority of rejections and denials are due to issues during the patient access process. For example, missing or incorrect eligibility information is one of the top reasons claims are denied.² And denied claims means denied revenue. By leveraging automation technology, manual processes like calling payers or searching payer websites for patient information can be eliminated. This can not only relieve staff of these time-consuming processes, but it may also enable physicians to reassign staff to more strategic or patient-facing tasks.

2. Shore Up Self-Pay Collections
The COVID-19 pandemic has had a negative financial impact on patients as well as physicians. Many individuals’ job situations changed, as well as their insurance coverage. Financial stressors, along with the growing popularity of high-deductible health plans, has made collecting from patients even more challenging. A great way to help both the practice and the patient is by providing patient responsibility estimations prior to or at the time of service. Doing so helps patients make more informed decisions about how to pay for their healthcare while also giving the physician the ability to proactively ask for payment. Educating patients about their coverage through a detailed estimation can also help improve patient loyalty and the provider-patient relationship.

3. Create Cleaner Claims
Coding has grown increasingly complex and burdensome for physician practices. While efforts are underway to simplify coding, new codes are being added to the already overwhelming library of more than 78,000.³ Simply staying up to date on coding can be a herculean undertaking. It’s important to make sure coders receive ongoing education and that they understand that the quality of the work they do has a direct impact on the bottom line. Physicians may also want to employ technology that filters and flags claims with issues so they can be fixed and resubmitted before they hit the payer’s adjudication system.

4. Improve Payer Management
Payers are denying a record number of claims. To protect revenue, it’s important that physician practices make staying on top of payer requirements a priority, especially requirements that apply to prior authorizations, timely filing, and appeals. It can be helpful to assign specific staff to own a particular payer or set of payers. Increasing ownership can help optimize payer management and reduce cash flow issues down the line.

5. Leverage Predictive Analytics
Identifying opportunities for improvements can be difficult. It’s often the things you don’t see that are causing the greatest issues. Implementing predictive analytic software gives physicians critical insight into practice performance and payer behavior. For example, understanding payer reimbursement patterns for certain types of claims can help physicians assign resources more strategically. For example, if a payer doesn’t remit payment for care until day 14, then there’s no need to work on those accounts until day 15 or after.

6. Consider Outsourcing
In some cases, it can be more cost effective for physicians to partner with revenue cycle experts to help them achieve operational excellence faster and more effectively.