In today's healthcare environment, capturing every penny of hospital revenue is challenging. There are many reasons that inhibit recovery, such as satisfying payer documentation and meeting coding requirements. Items for billing and revenue collection are difficult to manage. Complexities in the billing process and subsequent financial documentation create opportunities for breakdowns in the income cycle, which often result in loss of income.
In addition to the typical challenges of raising revenue, the upcoming conversion to ICD-10 and the advent of new legislation creating health care reform offers more challenges than revenue cycle executives must overcome.
There are many proactive operating strategies available to providers to help improve financial results. Process improvements can come from human capital adjustments or the use of innovative revenue cycle technologies. Unfortunately, regardless of the method or methods chosen to help improve revenue capture, leakage and opportunities for loss of income are likely to occur.
The need for revenue capture audits
A great source of lost income stems from highly complex and laborious tasks where human error is the cause. The information required to make certain determinations comes from various departments within the hospital. Skilled personnel shortages, inadequate technology solutions plus full-time equivalent (FTE) turnover are contributing factors that lead to time-consuming and complex claims processing errors and the provision of supporting documentation to meet requirements. government reimbursement.
Revenue capture audits can identify and capture revenue, which often seeps through the revenue cycle, and the audit itself can provide valuable insight that helps find the root causes of workflow hospital bill auditing.
Providers are challenged to assign enough full-time staff to review and correct many billing issues before they generate lost potential revenue. The following five key areas offer opportunities to discover incremental revenue by conducting revenue capture audits:
- Identify missed bad debt opportunities
- Identification and forwarding of unseen claims for Medicare DRG reimbursement (TDRG)
- Discover valid Medicaid eligibility coverage
- Discovering disproportionate hidden Medicaid payments (DSH)
- Ensure that proper shadow billing requirements are met
Identifying and rebilling income loss opportunities requires a compelling understanding of significant changes in Medicare and Medicaid, a close working relationship with all individual tax intermediaries, direct access to the Medicare and Medicaid EDI information channels, and access to engines Data analysis for faster and better information. recovery determinations.
Due to the complexity and skill required to capture all sources of revenue, many hospitals turn to revenue audit experts who offer outsourcing services or specialized technology providers who offer niche technology solutions for internal staff to audit internally.
What to look for when selecting a technology audit or revenue capture outsourcing provider
Choosing the right provider is of utmost importance. Not all sellers are equal in quality and capacity. Also, not all providers will be right for your hospital or health system. Most importantly, it is essential to select the right provider that you think can collaborate comfortably and effectively.
An important consideration when selecting a revenue audit provider is choosing a company that can demonstrate a history of successful performance and skill. Consideration should also be given to providers who have competencies in all five revenue capture areas and who offer the option of an internally powered technology solution that can be managed by hospital staff or an externally outsourced service solution.
By offering two models for performing revenue audits, revenue cycle executives have the option of choosing a solution that fits the corporate culture and financial goals of the healthcare or hospital system.
No comments:
Post a Comment