Initiatives
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The document discusses initiatives to enhance cash collections and revenue cycles for healthcare facilities. It outlines strategies to improve front-end collections, back-end billing, and recovery of unpaid receivables. Methods include analyzing denial trends, charge capture processes, and tools for tracking accounts, reviewing contracts, and documenting follow-up actions. The goal is to increase cash flow by reducing aging accounts receivable.
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New York Office - 41 Madison Avenue, 25th Floor, NY 10010
Phone - +1 212-400-6100, Email - contact@sunknowledge.com
Website - www.sunknowledge.com
Facebook - https://www.facebook.com/SunKnowledge
Twitter - https://twitter.com/sunknowledge
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Insurance changes are upon us with January 1st right around the corner. Now is the time to review your internal processes and be sure your team is ready for the upcoming changes and prepare if not!
Every healthcare practice must verify coverage before services, especially in the new year. If needed, we can implement new protocols within your office to be more proactive about patient copays, co-insurance, deductibles, and even patient past-due balances.
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Using a comprehensive initial assessment, re|solution identifies areas where a facility has not received full reimbursement. re|solution guarantees its assessment and implementation costs will be covered by additional reimbursement identified. re|solution then works with departments quarterly to improve documentation and coding practices to ensure full payment. It also monitors implementations for a year. Again, costs are covered by additional reimbursement. The program provides rural hospitals assistance with revenue cycle issues and a "safety net" to ensure receiving all money owed.
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Greetings,
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MS & BS Mechanical Engineering (HON), USAGreetings,
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Initiatives
- 1. a Beverly Brouse Creation Initiatives • Cash Collection Enhancement • Front-end, Back-end & Indigent/Uninsured • Revenue Cycle Enhancement • Process Improvements Identified through Denial Trends • Charge Capture
- 2. a Beverly Brouse Creation Cash Collections Enhancement • Cash Flow Analyses (Provide training, guidance or solutions) • Front-end » Facilitate collection of co-pays for scheduled, elective & emergent procedures • Back-end » Facilitate productivity monitoring & tracking » Facilitate worklist maintenance & collection efficiency » Perform third party payor A/R recovery » Perform third party payor credit balance clean-up • Indigent/Uninsured Patients » Facilitate up-front eligibility screening » Facilitate financial counseling
- 3. a Beverly Brouse Creation Revenue Cycle Enhancement • Denial Based Analyses (Provide training, guidance or solutions) • Identify third party payor denial trends • Identify root cause of denial » Document current procedure flow » Identify process improvements » Provide remedial action plan » Perform further analysis, when necessary (interviews/researching policies and procedures) • Facilitate action plan • Charge Capture Analyses • Perform charge flow verification » Service > Superbill/Ticket > Charge/Billing system > CDM > UB
- 4. Third Party Payor A/R Recovery a Beverly Brouse Creation Tools Utilized • Tracking database (for logging all activity) • Available on-line payor assistance programs (for checking claim status) • Ohio Prompt Pay Guidelines • Action checklist (for performance guidance)
- 5. Third Party Payor A/R Recovery a Beverly Brouse Creation Required Access to… • Aged trial balance • Commercial payor contracts • Health Information System • Medical Information System (i.e. ChartMaxx) • Explanation of Benefits (for 2ndary payor balances) • Phone & listing of payor contact information
- 6. Third Party Payor A/R Recovery a Beverly Brouse Creation Action Checklist • Work claims in priority of high dollar & age • Group claims by payor for maximum efficiency • Review account history & determine required action (i.e. contact payor, CSA correction, provide additional information, request for rebill…) • Perform action • Document action taken & anticipated result • Revisit account once a week until resolved
- 7. Third Party Payor A/R Recovery a Beverly Brouse Creation Maximize Hospital Recovery • Data shows that the likelihood of collecting reimbursement decreases significantly with every passing day. Our services focus on the collection and clean-up of these aged third party payor receivables. • Often times, aged receivables go un-worked due to the constant submission of new claims, equipment restrictions, staff limitations, or productivity inefficiencies. With our services, we will assist in the reduction of aging A/R, increase cash flow, identify billing, payment and posting trends, and provide continuous feedback on an ongoing basis.
- 8. a Beverly Brouse Creation Third Party Payor Credit Clean-Up Tools Utilized • Tracking Database • Balance Determination Template Required Access to… • Commercial Payor Contracts • Health Information System • Explanation of Benefits
- 9. a Beverly Brouse Creation Revenue Cycle Enhancement Tools Utilized • Interviewing Questionnaires • Microsoft Visio Flowcharting Software
- 10. a Beverly Brouse Creation Revenue Cycle Enhancement Required Access to… • Policies and Procedures • System Flows/Interfaces • Denial Reports • Error/Edit Reports
- 11. Revenue Cycle Enhancement a Beverly Brouse Creation Denial Analysis Common Denials/Scenarios • Pending Receipt • Pending Additional Information • Untimely Filing • Medical Necessity Disputes • Usual and Customary • Non-Covered Service/Item • Precertification/Preauthorization Disputes • Policy Exclusions • Beneficiary Number Not Found • Contract Disputes • Prompt Pay Violations