Tag: RCM Operations

16 Apr 2016

Six Quick Tips To Minimize Charge Entry Lag


Running a successful ambulatory surgery center is tough. From managing costs to tracking metrics to ensuring smooth flow of revenues.

An optimized billing cycle results in a regulated reimbursement cycle.

A more basic and often neglected aspect of the billing cycle is the lag days analysis. Most centers are unaware of the lag between the date of encounter to actual claim submission. Lag days lead to an uncertain revenue cycle.

Problems with an uncertain revenue cycle.
1. Revenue prediction becomes difficult.
2. Revenue cycle is never standard.
3. Identification of problem areas becomes strenuous.

Tackling lag days.
Ideally, submit all claims within 24 hours of the date of service.

If this isn’t happening, there are only two possible scenarios:
Either physicians are not completing their charts on time or the claims are not sent on time.

[Read: Six Productivity Hacks For Physicians]

Here are six quick tips to manage lag days:
1. Try to complete encounter documentation while you see patients. For consultations, enter the consultation and diagnosis codes during or soon after the visit. For procedures, aim to complete all encounter documentation immediately or before the end of day.
2. Make most use of technology. Invest in an EHR/practice management software that integrates billing. Using a mobile solution can help you complete billing on the move.
3. Customize encounter sheets or EHR modules to match your style of work and lower the time spent on each case.
4. Automate the billing cycle wherever possible. Use OCR software to extract relevant text from scanned encounter sheets. Couple it with custom automation scripts to document CPT and ICD codes within an EHR/PMS.
5. Use a rules based engine for quality. The engine cross-checks all claims with coding guidelines for compliance.
6. Use a real-time eligibility tool to verify coverage details before and at the time of service. This activity will curb charge lag due to missing coverage and benefits.

Establish benchmarks on the acceptable lag limit for submitting claims. Maintain and track the lag day report and work on efficiency.


11 Ideas to Grow Your Medical Practice in 2017


16 Apr 2016

Simple Methods to Ensure 100% Claim Submission


Reimbursements depend on the number of clean claims submitted to insurances, hence the count of claims that go out of the system everyday becomes an important number to track. Many centers tend to overlook this number and so there is no way for them to be certain if all claims go out of the system. This is a more serious problem than it seems, because physicians spend time, energy and resources seeing patients and missed claims eventually result in loss of income, a bloated AR and dissatisfied doctors.

Here are three steps to ensure effective claim tracking:
Missing Claims Log
At the end of each claims submission cycle, the billing staff must run a report from your practice management system of all the claims submitted to insurances. Cross verify the number with the total patients seen for that particular cycle. Both numbers must match. For example, if your billing report indicates that 170 claims were submitted for a certain date of service, then 170 should be the number of patients seen on that date. Any discrepancy with the number will mean that there are claims that have been missed.

Open Claims Log
There might be instances when a physician may forget to digitally approve a particular visit or she may have saved the claim as a draft in an EHR and forget to submit. If using paper charts, your billing teams receive a batch of claims with missing information on a particular chart and decide to keep it on hold. It is important to keep a track of such claims. Deploy a detailed open claims log and have your billing staff document the occurrences of such claims. While reviewing the open claims take the necessary action to reconcile the claims. This ensures no claim is pending in the system.

Weekly Reports
Along with running reports for missing and open claims every week, run a ‘no show’ report for patients who missed their appointment during a week. Use these numbers to verify that no claims were missed and analyze trends over a period of time to reduce discrepancies between patients seen and claims submitted.
The alternative is to use good software that automates the above for you.

02 Apr 2016

Say no to NO SHOWS


On a typical day, you check your schedule and plan your day accordingly. The first patient walks in, checks out. Second patient walks in, checks out. You call in for the next patient. Guess what, the patient never made it to the appointment. The patient is a NO SHOW without prior notice. The rate of no show visits varies from 10% to 60% across the country. That’s a very big number to consider, adding to lost revenue and time.

The restaurant paradigm
According to a study, many restaurants now charge consumers for missing a reservation. It suggests that there is a 3% to 5% margin drop involved in missed reservations. The story is not that different in medical practices. No shows eat up your time and dollars. Each missed visit is a waste of essential time that could have been used for other patients calling in, requesting to be seen that day. Sure you may be lucky enough to have a walk-in patient at the time of no show but it’s unlikely.

Managing no shows
Many practices resort to scheduling multiple appointments for a particular time slot, so if there is a no show the time is made up for. But this causes delays when the scheduled patients do show up. It’s a common technique but patients suffer through loss of their time. So, how does one fix this? A few thoughts.

Intelligent scheduling
In most of the cases, the follow up visits are scheduled on the same day the patient had first come for a visit. Evaluating whether the follow up visit is absolutely required, the time span between visits can lead to cleaner scheduling, lesser confusion and lower patient wait times.

Patient suggested appointment time
According to a survey by University of Missouri that looked at 11,000 scheduled patient visits, patients who suggested the most convenient time for an appointment were more likely to show up. When patients suggest a time they are more likely to take into account their personal commitments and less likely to miss the appointment under any excuse.

Online appointment scheduling
Encourage patients to use your patient portal. This gives them the liberty of scheduling appointments themselves. It’s a time and effort saver. Patients, while scheduling their appointments, are more responsible and more likely to make it to the visit. This also reduces the chores of your staff.

Reminder protocols
Have patient visit reminder protocols. Setup processes to call patients one or two days prior to the appointment. This can be done manually by the staff or by using customized automated calling systems.

Cancellation and No Show Policy
After carrots, comes the stick. But it aligns very well with taking proactive steps to better manage no shows and cancellations. Build a simple and precise cancellation and no show policy. It needs to clearly reflect consequences of not notifying the cancellation or no shows beforehand. You might avoid using it for a patient’s first no-show, or waive it if a no-show patient becomes upset and promises to do better next time. Frame the policy at obvious places in your practice that are bound to get a patient’s attention – typically waiting areas and front-desk.

Try any of the methods or come up with some of your own. Reducing missed appointments improves your practice’s bottom line and helps with a more seamless workflow.

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