Doing more with less is the mantra among many of today's businesses, but even more so among companies within the healthcare industry. Tighter regulations and decreased reimbursement, combined with the uncertainty of healthcare reform initiatives, has many hospitals and physician practices looking for ways to decrease costs and boost efficiency.
Fortunately, there is much that organizations can do achieve their goal of doing more with less if they leverage technology to automate processes. It's important to remember that leveraging technology doesn 't necessarily mean buying new technology. On the contrary, substantial improvements within an organization can take place by simply reconfiguring and optimizing existing technology, such as practice management systems, as well as related coding, billing and clinical documentation systems. At many organizations, these systems are not being used to their full potential. Simply taking the time to reconfigure these systems and related processes can make a positive impact on the revenue cycle.
Outsourced billing is another option to leverage technology without making large, up-front investments. Since many outsourced billing companies earn their fees as a percentage of collected reimbursement, this is a viable option for organizations to improve their billing processes without incurring up-front costs. Outsource billing companies automate processes to increase efficiency and provide an immediate workload decrease to organization's administrative staff.
Whether leveraging capabilities within existing systems or outsourcing, organizations should consider the following areas as they look to increase automation:
Eligibility Checking - Patient eligibility status changes often. Although nearly all organizations perform pre-service eligibility checking, patient eligibility status can change during the time between initial verification and claim submission. The result is unnecessary claim rejections and denials that require staffing resources to correct. One way to resolve this is by automating the processes of checking eligibility before service is delivered, as well as re-verifying eligibility before the claim is submitted. Many practice management systems and outsourced billing services support this automated process.
Automated Claim Status Checking - Claim follow-up time can be decreased substantially by automating the process of checking claim status at user-defined intervals. For example, a claim submission that didn 't receive a clearinghouse or payer response within an expected timeframe could trigger an automated claim status inquiry. This automated process can also be used to check payment status. Automating this process greatly reduces the number of accounts that need to be verified manually. Once again, many practice management systems and outsourced billing services support this automated process.
Claim Scrubbing/Business Rules - Practice management systems and billing services need to automate the process of scrubbing claims against federal, state and payer-specific business rules to identify claim errors prior to submission. Claims with errors can be corrected and resubmitted to avoid delays in reimbursement.
Most importantly, organizations looking to automate processes need to carefully weigh potential benefits against processes that obstruct workflow. Properly configured systems and billing services assist with workflow, not impede it. The above examples provide just a few areas where organizations can automate processes to do more with less, but numerous other opportunities exist. Doing more with less is as much a philosophy as it is a necessity. Focusing on key areas where automation can deliver benefits, and taking an incremental approach, can help organizations reduce cost and increase performance.
William A. (Bill) Carns, MBA, CMPE, CHBME is chief executive officer of PracticeMax, a revenue cycle management organization that provides billing & coding services, practice management & EMR software, and consulting for medical businesses and clinical operations. He can be reached at billcarns@practicemax.com or 480-374-7201.
