Our expert AIMA healthcare account managers share their best practice advice on how physician practices and laboratories can successfully improve cash flow.
US-wide physician practices and laboratories continue to report financial challenges relating to COVID-19. Consequently, maintaining cash flow has never been more vital. Many are witnessing a decrease in their patient volumes and revenue as well as significant increases in pandemic related expenses, such as technology to support telehealth, remote staff working and PPE costs. Is this something you’re experiencing or worrying about?
Robust cash flow management is essential for any business. Healthcare is no exception; what’s more, COVID-19 is directly impacting income for many physician practices and laboratories. AIMA customers can be reassured. All money owed is received in the most efficient and timely fashion using our proven revenue cycle management systems. Therefore, allowing them to focus on safely caring for their patients.
Aaron Liston, AIMA CEO
For many, the maintenance of healthy cash flow has become a daily battle for survival. So what’s the solution? Here we look at five easy steps to improve cash flow with effective revenue cycle management.
1. Get to know your payer
It is essential to know your payer. Every biller is supposed to follow the CPT (Common Procedural Technology) guidelines maintained by AMA. There’s just one problem, in reality, there is a high volume of variance from payer to payer, especially between Medicare and Medicaids on certain services. For instance, inconsistencies in frequency, units, and diagnosis codes are commonplace. Let us clarify, it is crucial to develop a system to ‘scrub’ the claims for these specific payer guidelines and bill accordingly, avoiding denials and costly rework. For example, some payers do not allow Level 5 codes regardless of the elements involved or the standard of medical decision making.
Here’s the bottom line, creating a customizable scrubbing system will go a long way to ensuring first-time valid claims and compliance.
2. Set your 24-hour turnaround target
We all know that implementing a 24-hour billing policy is a challenging task. Many physician practices, surgical centers and laboratories struggle with the workforce to accomplish such a task. Couple this with widespread difficulties to complete timely chart sign-offs and the whole process can become a daunting task. Fortunately, there’s a simple solution, a weekly reconciliation of appointments against charts, superbills, and claims. All good revenue cycle management companies, with a specialist billings function, should complete this work on your behalf. RCM companies use a mix of manual reconciliation by billing specialists and robotic process automation to achieve the turnaround target.
All AIMA service level agreements have the 24-hour clause regardless of volume fluctuations. Therefore, throughout the COVID 19 pandemic, we have experienced claims see-sawing from 100 to 1,000 per day per client. However, all have been actioned, we are pleased to report, using a blend of manual input and process automation.
3. Denial and rejection process
Ironically, the goal of an effective denial management system is not to have any denials at all. Here’s something we can both agree on, every practice should strive towards reducing their monthly percentage of denied claims. So what’s the solution? An expert team adept in handling denials can facilitate this for you, learning from the previous denials and making necessary corrections for the future. It is no secret, learning from your mistakes can be costly and time-consuming. Compare this to using the expertise of a revenue cycle management company with multiple similar clients who have already learned the lessons and developed the processes.
We’re sure you will agree if you want to improve something the best place to start is by observing trends and reporting it (i.e. denial percentage, denial resolution rates, denials missing timely filing). Moreover, once armed with this data, you are in a stronger position to implement a successful denial and rejection management system.
4. Adopt an intelligent AR strategy
In a perfect world, there would be no such thing as Accounts Receivable (AR). You guessed it, claims would be paid or denied allowing practices to manage cash flow by working on denials promptly. Unfortunately, this Non-AR utopia is a pipe dream.
We all know, claims frequently get lost in the labyrinth of clearinghouses and payer adjudication systems. So what’s the answer? A seasoned AR team. They know how to navigate through the seemingly unending twists and turns to ensure successful payment. You don’t want to miss this part, make sure you classify the no-response claims to aging buckets alongside filters such as high-dollar value, payers, etc. You can then use this to inform an intelligent AR strategy. AIMA has a proven track record of AR estimation audits and collecting maximum revenue from AR previously listed as non-collectable by the regular billers.
5. Allocate for success
Payer payment timelines are one of the most significant factors affecting cash flow management. Accompany this with issues with dollar value, aging buckets, agent specialization and denial type and, before you know it, your income is drying up.
At AIMA we use a proprietary AR inventory management tool to facilitate the complex task of work allocation. Moreover, the system utilizes an algorithm to identify potential areas of uncollected revenue and allocates accounts to automation and human agents. But that’s not all, it looks at payer geography to understand the best time to reach them based on their time zone. Final point, to help you improve cash flow for your physician practice is to never stop observing trends and patterns early in the process and assign actions to agents specialized in such tasks.
“The AIMA team’s skills in medical coding, billing and credentialing is unparalleled by any organization I have worked with. I appreciate your patience working through systems and financial viability.” Portable Imaging Service, Montana