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Reducing Reimbursement Risk: Communication and Training

This blog post is based on a recent webinar featuring Susan Gurzynski-Wells, Senior Product Manager, who specializes in coding and revenue cycle management at HealthStream.

The AMA reports that in 2013, hospitals were underpaid $51 billion for medical services. The average denial rate for Medicare patients that year was 4.9%. On top of third-party payment issues, hospitals dealt with internal issues like point of service collection issues at the front end of the revenue cycle and claims errors discovered on the back end. Both are within our control to improve.

Improve Upfront collections

According to the Wall Street Journal, “hospitals are 60% less likely to receive payment for the patient portion of the bill once that patient leaves the hospital.” We know patients’ higher out-of-pocket costs are here to stay, but many providers haven’t mastered the art of collecting the accurate amount of a patient’s obligation at the point of service each time the patient is seen. It’s critical that we train patient access staff to understand patient financial responsibility and to communicate confidently during the initial collection encounter.

Start Financial Conversations Early

In our research, we discovered that starting financial conversation with the patients ahead of the visit increases collections. Effective collection begins as early as scheduling and continues at registration. Conducting the registration process accurately and completely is also critical to the revenue cycle. In fact, educating a patient about his or her financial obligation in advance improves patient satisfaction.

Consistent Collection of Payments and Data

Additionally, every patient access staff member should be following the same, standardized procedures. It’s difficult to manage a mixed bag of different practices, and inconsistency is more likely to reduce collections and reimbursement.

At registration, data is collected and stored, including insurance information, provider eligibility, and diagnosis codes. By recording this patient data accurately, we facilitate an effective claims process.

Reducing Claims Errors

Here’s a typical example of how claims errors occur: A patient comes in with an order for a unilateral ultrasound of the breast for a suspicious lump. The ultrasound is performed, and the technician selects a procedure code. Unfortunately, the technician has selected a code that had been deleted from the charge master in 2015. Why? She was trained by an expert in the department who created a cheat sheet of commonly used codes for popular procedures, and no one had updated the cheat sheet.

Technicians seldom use CPT books, guidelines, and annual changes to enter charges. The clinical professionals who enter codes often have a limited knowledge of code changes, new CPT guidelines, or changes in modifier applications. Many consultants report that clinician order entry staff have not been trained on simple charge entry legends, rules of use, or alerts. Even though they’re involved in the revenue cycle, they aren't necessarily included in revenue cycle training.  Employees need to understand how daily routines fit into the total revenue cycle, from registration to discharge. This understanding is essential to achieving both quality of care and revenue cycle excellence.

Education regarding their role in the revenue cycle and the importance of staying abreast of CPT codes will aid that technician in understanding charge entry and how it affects claim denials. If we can eliminate the problem at the point of charge entry, we can avoid denials and rework.

As healthcare professionals, we often operate in our own area of expertise exclusively and don’t embrace the idea that we are part of a bigger team. Patient access staff and clinical staff share a goal: optimal patient care and the money to pay for it.  

Watch the full Webinar. Learn more about our revenue cycle solutions.

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