Six Guidelines for Achieving Operational Excellence in Difficult Times
These are challenging times, especially for physician practices. Post-pandemic recovery has been hampered by skyrocketing inflation, increased costs, and ongoing staffing shortages, both clinical and administrative.1 At the same time, per-physician compensation has decreased. That’s why it’s so important to protect the practice’s revenue stream. And to do that, physicians need to focus on improving operational efficiencies.
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.
Case Study
The client is a large nonprofit, academic medical system that includes a thriving physician group working across multiple primary care and specialty care centers. The health system was experiencing issues with its long-time revenue cycle vendor. The vendor’s coding errors were out of control, and they weren’t able to provide accurate, timely practice information. To make matters worse, the vendor’s legacy system constrained the implementation of tools that could help improve the quality of their work, including coding. The client decided it was time to look for a new revenue cycle vendor.
The client chose to partner with Conifer Health because of the company’s extensive revenue cycle expertise and more than 30 years of experience. Conifer took a multiple-step approach, which included:
- Providing extensive training to help the client’s revenue cycle team better understand their EHR system
- Developing more effective business intelligence and reporting capabilities to increase data insight and allow for a roadmap to improvement
- Conducting clinical documentation improvement training for physicians
- Training staff to better identify and avoid denials
- Defining and aligning all revenue cycle goals to improve collections, reduce aged A/R, increase coding quality, and shorten turnaround times
With Conifer, the client was able to achieve significant results in a short period of time. The client’s CFO and COO was impressed with Conifer’s well-developed network of subject matter experts, many of whom were on-site, as well as their level of insight into best practices. The CFO explains, “When you talk to their IT, billing, or coding experts, you realize they are deeply experienced in every area.”
The CFO was also impressed with how involved Conifer’s senior leadership was in the relationship. “Involvement with senior leadership was really impressive,” he says. “It gave us a level of comfort.”
The Journey Forward
As physician practices struggle to recover from the financial impact of the pandemic, they need to do all they can to improve operational efficiencies and protect their bottom line. Automating processes and improving data insights can help, but these can be challenging for practices with limited resources. Partnering with revenue cycle experts like Conifer Health is a great way for practices to achieve operational excellence and optimize their revenue while on the road to post-pandemic recovery.
References
- https://www.kaufmanhall.com/sites/default/files/2022-07/KH_PFR_2022-07.pdf
- http://cthima.org/wp-content/uploads/2018/12/CTHIMA-Payer-Denial-Trends-Rocky-Hill-Dist-12.13.2018.pdf
- https://www.healthcatalyst.com/insights/changes-icd-10-pcs-codes-cms-updates-effective-october-2022