By Chandresh Shah
Wrong question. It is like putting a cart before the horse.
In the past few weeks, I have talked a lot about practice revenue and revenue cycle management. Let me focus on that as I try to explain what I mean.
Examine some possible problems or ‘current state of affairs’.
Example 1
Overall collections are not bad, but there are two issues that can be improved:
o Patient collections down
A few Denials are too many!
The billing department (in-house or outsourced) is doing a good job. The over-90-day accounts receivables are within industry norms, they work very diligently to pursue all claims and every last dollar. They are doing everything they can, within their power.
The problem is, that there are things that can be done better upfront – before the patient comes in before the claims go through. How?
- Getting pre-cert done for procedures beforehand.
- Getting eligibility for special types of visits before patients walk in so that you are not caught with pants down.
- Full knowledge of Patient co-pays, out-of-pockets and balance remaining on deductibles, before the patient comes in for a visit.
Solution(s)
Examine your practice workflow with respect to these specific problems.
- How/Who can check eligibility and other insurance details before patient visits?
- How/Who can check insurance details, outstanding patient balances, pre-certs, and authorizations?
- Once checked, what should be done to take care of and/or avoid downstream problems?
Example 2
Your practice receives a paper EOB and checks for 10 claims. You receive this check on the 1st of the month. Someone enters payment into your billing software and deposits the check into the bank. The person in charge of payment posting is not able to post the payment until after 2 weeks, say the 15th of the month, for whatever reason.
Problem:
The Billing Manager runs the ‘payment’ report where there is a discrepancy.
She wants the report to reflect the Payment Posted date to match the date when the check was received.
Read the above sentence again. Do you see anything wrong with this?
First of all, every activity in any system should reflect the date when that activity is performed. If the software reflects the date of payment posting on a claim as May 1 instead of May 15, that is exactly what it is.
So, why does the billing manager want the payment posted date as the date on the check? If the reason is to be able to accurately reconcile the claims payment date, then the payment posting process needs re-examination, not the technology or software!
Therefore, the answer is to link workflow and processes to Problems and Solutions rather than technology.
Conclusion:
Practices are too close to the problem to realize that the process is broken, or can be improved because it is based on assumptions and conditions that were established a while ago. Environments – business, and technology – change, which requires adaptability to change processes.
Successfully solving problems requires partnership and information sharing. It is a result of two or more people sharing the workload and committing to the same outcome.
If you see your vendor as a vendor that is simply making and peddling software, you’re on your own. If you see your vendor as a partner allow them to help you, they have a lot of experience and you don’t have to pay ‘consulting’ fees to more expensive health IT consultants.
A vendor that says yes to everything you want should be approached with caution. Is the vendor challenging you to think of your current state and encouraging you to visualize a better future state? If yes, proceed.
