Series: Steps to Ensure Provider Sustainability (COVID-19 be Damned)

In this series, I’m going to outline five steps to take now to improve the sustainability of your agency. Today we are going to discuss the relationship of revenue cycle management to cashflow. As the saying goes, “Cash is King”.

1. Prior Authorizations: Payers reimburse retrospectively. Which means you are paid after you provide the service. Therefore, it is highly important that you ensure prior authorizations are in place before beginning to provide services. This requires lock step communication and collaboration with payers and in many instances case managers.

2. Service Documentation: To ensure that you are able to bill accurately, your billing team should ensure that documentation is accurate, complete and meets billing guidelines as laid out in payer contracts and/or federal and state payor regulations. Some common documentation errors include timeframes missing specificity such as AM/PM, missing titles, missing signatures, and documentation that does not address the regulatory requirements as to what should be included for the service being billed. This will also help providers avoid payment recoupments in the future.

3. Billing: It is important to ensure that billing takes place as soon after services have been completed as possible. You should be billing claims at least weekly, if not daily. This allows you to get revenue in as soon as possible. While most payers batch payments, billing quickly allows providers to get paid as quickly as possible and address any billing issues as soon as possible.

4. Payment Reconciliation: To avoid “leaving money on the table”, providers should ensure that they are reconciling payments with what was billed and address any issues or discrepancies as soon as possible. This ensures that providers meet billing and appeal timeframes, for maximum payment.

5. Metrics and Process Improvement: Providers should establish metrics to determine the efficiency and effectiveness of their billing process. This will allow the provider to determine if there are opportunities to improve the process. Some sample metrics include: First Pass Resolution Rate and Net Collection Rate.

As our economy continues to be challenged, it is important that providers ensure sustainability. Revenue cycle management is how providers collect revenue and optimize their collection of third party payor payments, therefore this is absolutely the first step in ensuring your organization’s sustainability.