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When you’re running a hospital or healthcare practice, your primary goal is to ensure that your patients are receiving the treatment they need. The truth about it, though, is that in order to keep things running smoothly and to allow the doctors to continue to provide quality care, you have to optimize revenue cycle management so that claims get paid on time.

Running efficiently means you have to keep expenses low and speed reimbursement.  Let’s explore a few revenue cycle management solutions to make that happen.

Improvements in Denial Management

Few things can slow down cash flow more than denied claims. A denial can cause reimbursement that appeared to be coming soon to be delayed by months. Managing claims denials is a long process, and often require re-coding, resubmission, and a complex database to mitigate the risk of future denials.

Improved Eligibility Verification

Working with multiple insurance companies means that you have to understand the processes for each one of them.  Some procedures are covered without issue with one company, whereas it is a struggle to have a claim paid with another.

Eligibility verification is one of the most important ways you can optimize your revenue cycle.  Knowing that the patient’s insurance is valid and their treatment is covered is the first step. If treatment is administered without taking this step, you may never be paid for services rendered.

Medical Coding Optimization

It has never been more important to make sure that medical coding is entered accurately by your staff. But medical coding is vastly complex and your staff has to be educated as to procedures for each payer and the standard coding required. Having the coding process automated can reduce denials. 

Streamlined Medical Coding Audits

When we think of audits, we think of going back over the books and ensuring that everything was done correctly – in other words, reviewing what has already been done.  Medical coding audits, however, look to the past to improve the future. It is a way to ensure that submitted claims are done with a high degree of accuracy and quality. 

This circles back around to coding optimization and denial management.  Medical coding audits can help lower overhead by reducing the need for work to be done twice.

Faster Accounts Receivable Follow Up

In the world of A/R, having “the check in the mail” is a killer. Accounts receivable, also known as patient accounts, look good on paper and make the healthcare organization look like it’s doing well, but in reality, the cash isn’t there.

Having a strong and consistent follow-up with patients improves the reimbursement process. But it can be a drain on resources as the patient accounts must be ultimately collected by a staff member or outsourced to a 3rd party.

Improved Charge Capture and Billing

Patient treatment can be complex. Without a proper system in place to ensure that all charges are captured, and medical coding has been optimized, reimbursement for services can be slowed or denied.

While almost every hospital executive would say that charge capture and billing is one of the most critical components of their revenue cycle, many haven’t put the systems in place that are necessary to prevent loss, reduce denials, and optimize reimbursement. 

Prior Authorization

Prior authorization (PA) is an essential part of the revenue cycle. If the procedures or medication are not pre-authorized by the payer, the claim will rarely be paid. It’s very important that procedures are in place for PA best practices to ensure maximum and timely reimbursement for services. Unsanctioned procedures, incomplete documentation and missing patient information can all result in unapproved PA.

Revenue Cycle Management Solutions from Advantum Health

When one aspect of your revenue cycle management is out of place, it can throw off the entire reimbursement schedule. Advantum Health offers solutions for the revenue cycle to ensure less overhead and faster reimbursement so you can provide better care to the patients that walk through your door.

Contact us to learn how to improve your revenue cycle.