Patient care is the top priority and a source of passion for physicians, but making sure the business side of your practice is healthy also can contribute to better outcomes and patient satisfaction. Learn six ways to streamline revenue-related processes to maximize the amount of time available for patient care.
Speed up your processes electronically
The AMA’s STEPS Forward™ collection of practice improvement strategies can help your practice streamline revenue cycle management processes. The module details several ways for your practice to become more efficient in these processes, which is critical for financial health and sustainability.
It is important to have a practice management system (PMS) that works best for your staff and medical personnel before you implement new processes. Your PMS will determine your practice’s ability to take advantage of electronic processes. If you are choosing a new PMS, be sure to gather input from your staff and make a priority checklist to find the PMS that aligns with your needs and requirements—and make sure that system works with your electronic health record (EHR).
Once you have a PMS in place that works for your practice, take advantage of these six ways to make your revenue cycle management processes more efficient:
- Verify insurance eligibility electronically before visits. Most health plans allow patient eligibility to be verified by phone or through a Web portal, but these methods are often inefficient and may not provide all the necessary information. Electronic eligibility verification can be a big time-saver. When a patient schedules an appointment, the scheduling or registration staff collects their insurance information and submits an electronic eligibility request by entering the patient’s data into the PMS. Federal regulations require health plans to respond within 20 seconds. Patients can then be made aware of any financial responsibility that will be requested at check-in.
- Reduce prior authorization burdens through electronic transactions. Newly available electronic pharmacy prior authorization transactions enable physicians to complete prior authorization requirements as part of the e-prescribing work flow. E-prescribing system vendors are in various stages of implementing the technology for these transactions, so find out your vendor’s timeframe and request this new technology for your practice.
- Submit claims electronically to save time and money. Submitting these health care claim submissions electronically can save time and speed up health plan adjudication and payment. After your PMS generates an electronic claim, your practice can either submit it directly to the health plan or indirectly through a clearinghouse or billing service, which may pre-audit or “scrub” claims prior to submission to check for missing or incorrect information.The built-in checks allow any potential issues to be addressed before the claim reaches the health plan’s adjudication system, reducing payment delays and denials.
- Determine the status of a submitted claim. Practices often don’t know if a claim has been received by the health plan until it is paid, pended or rejected. Use an electronic claim status inquiry to confirm receipt and determine status of submitted claims.Health plans are required to support real-time claim status processing. Practices can send “batch” transmissions to health plans to check the status of multiple claims at the same time. By law, health plans must respond by the next business morning. Rather than waiting two or more weeks before taking action, the electronic claim status request provides your practice with an immediate status report on the claim.
- Use electronic remittance advice (ERA) to simplify processing of payment information. An ERA is an electronic version of a paper explanation of benefits and holds all of the same details. The standardized ERA can reduce burdens, more quickly identify claims that require reworking and save time for staff to spend on higher-value activities. When implementing ERA in your practice, engage all involved trading partners, including health plans, your PMS vendor and any billing service that your practice uses. Determine the ERA capabilities of your PMS software. Taking full advantage of the ERA transaction may require an upgrade to the software. You can use the critical conversations with trading partners about ERA tool in the STEPS Forward module to make sure you cover all the bases.
- Maximize collection of patient payment. The growing prevalence of high-deductible health plans means many patients bear additional financial responsibility for their treatment. Collecting payments while the patient is still in your office is a vital first step in any effective patient collections strategy. It will increase cash flow, decrease accounts receivable, and reduce billing and back-end collection costs. To bill at the time of service, your staff will need to know the correct amount to charge. Completing an electronic eligibility check before the appointment will provide information about the patient cost. Use this information, along with the health plan’s current fee schedule, to calculate the amount the patient owes.
More than 25 modules are available in the AMA’s STEPS Forward collection, and several more will be added later this year, thanks to a grant from and collaboration with the Transforming Clinical Practices Initiative.