Hospital Revenue Cycle Management: Coordinating Data for Clean Claims and Better Service

Revenue cycle management in hospital settings involves a complex tangle of administrative and clinical functions—before, during, and after treatment. The prime directive of institutions is to provide quality patient care, but it’s only possible when treatment—accompanied by accurate paperwork and timely billing—results in collectible charges. After all, providing care is a business. Hospitals can’t afford to have personnel, services, or their bottom lines compromised by poor revenue cycle management.

Patients expect top-quality treatment, yet getting paid for services is complicated:

• Payers negotiate fees downward, causing hospitals to inflate fees.
• Varied requirements from insurers result in missed details and deadlines, causing late claim submissions.
• Medicaid and Medicare won’t pay unless every piece of documentation is in place.

Changing regulations and insurers’ variable standard operating procedures (SOPs) create challenges, too. Tracking and managing documentation amid diverse payers and changeable rules is like aiming at a moving target.

Common and costly errors in medical billing

Like any business, hospitals count on being compensated promptly for services rendered. Yet often, payments are unnecessarily delayed or claims are denied, negatively affecting institutional cash flow. Mistakes, incomplete paperwork, duplicate files, and documentation that can’t be found hamper collection of payment for services. Staff must make sure every required document, detail, and signature is in place so that sufficient documentation can be provided to the right people—quickly— for payment to be assured and prompt.

Improve your revenue cycle management with ECM and BPM

Enterprise content management (ECM) software gives staff instant desktop access to patient information, including admission paperwork, insurance documents, billing information, and more. Whether it’s captured from paper documents, online forms, or found in images, faxes, or emails, ECM makes sure documents are thoroughly indexed, appropriately secured, and immediately available to those who need them.

With ECM, no documents are lost, duplicated, or inaccessible. All the information workers need to submit timely claims and invoice for services is available at their fingertips instantly. Browser-based digital access ensures authorized staff can view documentation needed to perform their jobs, wherever they are.

Business process management (BPM) software builds on the information stored in ECM, ensuring routine processes move forward efficiently. Rules-based processing makes sure workers handle claims in the right order, along with documentation that’s accurate, consistent, and complete. Deadlines are no longer missed when claims workers are absent; instead, tasks are reallocated by job role, staff workloads, or other criteria you put in place. Work keeps moving.

Create a clean claim

For timely billing, claim review, and payment, data accuracy is critical. Clean claims require swift, detailed communication between all departments and individuals involved. A timeconsuming and costly chase begins if anything is overlooked, including:

• Patient demographic data.
• Complete insurance information that’s been documented and verified.
• A final diagnosis that’s been coded properly.
• Detailed charges for services, with supporting documentation.

How ECM and BPM can help:

• Integration with administrative (including billing) and clinical software applications (Epic, Siemens, Eclipsys, CPSI, etc.) ensures patient-related data that’s needed is accessible, searchable, and can be extracted easily.
• Claims are automatically prioritized by your rules, ensuring timelines are met.
• Items requiring internal approval, signatures, or other actions are forwarded quickly, following the hierarchies and rules you set in place.

ECM and BPM work in tandem to ensure claims paperwork is clean, correct, and submitted on time. Turnaround times are shorter; more qualified claims are submitted; quicker payment ensues.

Minimize the number and cost of denials

Insurers, subject to increasingly stringent regulations, only pay claims when their rules are followed. Variable SOPs, new rules resulting from changing regulations, and chaos amid mergers and acquisitions make tracking a nightmare. Administrators must be agile and alert to ensure timelines and conditions are met.

SOPs help to ensure that services rendered are necessary, treatment is relevant to each patient’s needs, and funds aren’t wasted. Although some claims are denied because of inappropriate patient care, more often they are rejected because of mistakes such as:

• Incomplete or untimely documentation.
• Overlapping dates of services.
• Prescriptions for costly treatments or drugs without preapproval.
• Forms missing pre-authorizations or pre-certifications.
• Insufficient documentation.

ECM and BPM assume the burden by:

• Prioritizing claims by receipt date, status, deadlines, etc.
• Reassigning tasks based on staff roles, work volumes, or other criteria.
• Alerting workers to information that needs to be corrected or completed.
• Assuring appropriate billing via drop-down menus that eliminate errors.
• Alerting staff when claims information is complete and ready to be billed.
• Automatically reassigning difficult claims to alternate workflows for specialized handling.

ECM and BPM follow your rules explicitly, letting you focus your energies and expertise on exceptions that require careful thought and skill. As new guidelines are received in response to changing SOPs and regulations, BPM adapts instantly to changed instructions. Claims are immediately re-routed as needed; you can be confident they will be processed following the latest rules.

Managing documentation digitally means you can track each claim’s progress as it flows through the system. Collection is faster. Bad debts decrease. Profitability rises. Customer service also improves.

Results

ECM and BPM unravel the complex tangle of documentation required for successful billing, claims submission, and revenue collection:

• Digital capture makes files useful instantly.
• Thorough indexing guarantees files are found when they’re needed.
• Integration makes information that’s scattered in multiple software applications available and useful.
• Automation hastens the flow of work, guaranteeing processing rules are followed.
• Rules-based direction of tasks lets you adjust the rules as needed, ensuring swift and accurate system response to regulatory and other changes.
• Browser-based access brings work and information to the right people, wherever they are, whenever they need it.

Together, ECM and BPM remove the burden of tracking and organizing, inform workers when tasks require special attention, and let employees focus their skills and energies where they’re needed. Smart technology frees your workers from the paper chase, letting them focus their time and resources on helping patients so they can leave your institution satisfied, ready to resume the daily business of living.

For more information or to schedule a demonstration, please Contact DocFinity now.