A List of To-Dos to Stabilize Your RCM Process in 2022

The pandemic has caused hospital operating margins to hit rock bottom levels. This trend is expected to continue in 2022, as the third phase threatens to bring life to a standstill once again. Given that hospitals are operating on extremely tight margins, it’s important to take steps to ensure their revenue cycle management process does not let them down yest again. To avert such a possibility, clinics and hospitals need to tighten the critical aspects of their Revenue Cycle Management process. Much of this has to be done from the lessons learnt in the way revenue cycle was handled in the last two years. This blog tells you all that you need to do to stop your businesses financial health from suffering a similar fate this year.

1)     Emphasize on Correct coding

In the backdrop of emerging Covid-19 variants, mistakes in billing due to improper coding will continue to see a rise in 2022. Therefore, getting coding right at the very first instance will matter more than anything else for healthcare providers.

Did You Know During the pandemic about 50% employees worked remotely; only 17% of coders worked entirely on-site.

Include the following in your coding initiatives to stabilize your Revenue Cycle Management process:

• Have a special team for Covid-19 coding, have a process flow to ensure the team is up-to-date with additional categories that are likely to be activated in ICD-10 & 11 to tackle Covid-19 variants
• Have a multi-tier quality control team to check specific coding issues like incorrect modifier usage, identify and correct upcoding and under-coding etc.
• Incorporate and follow the best practice for your charge reconciliation process. Have a new acceptable lag limit, reconcile missing charges, develop a lag report tracking mechanism etc.
• Use 100% certified and preferably experienced medical coders to code a bill; in case of shortage of skilled coders, partner with an offshore vendor with right credentials.

2)     Make it an Objective to Submit Clean Claims

In the last two pandemic hit years, providers had to lose a lot of time and money on resubmitting claims. Drawing from this, the very first things to do to optimize your Revenue Cycle Management process is to have all mechanisms in place to submit clean claims the first time.

Only 80-85% claims are accepted in first submission, against an acceptable standard of 97%.

Include the following in your claims submissions steps to stabilize your RCM process in 2022:

Introduce real time eligibility or batch eligibility checks. This will help you auto-generate the correct patient information with respect to patient demographics and coverage and eliminate the need to re-key patient data.

Have in place the right software solution and right technology partner; this primarily means having a custom-made rules engine to meet your needs comprehensively, configured every now and then to best meet the needs of your practice.

Have a separate team to analyze all rejections; configure your rules engine based on rejection analysis results. Configuring rules based on inputs will improve your billing practices and make first time submissions more accurate.

3)      Make Payer and Patient Correspondence a Top Priority

In the last two years, on-time correspondence with both payer and patient has taken a back seat for obvious reasons.  This has been one of the primary reasons for delays or denial of reimbursements during the pandemic. In 2022, it’s important to have a mechanism to ensure correspondence takes place on a 24-hour basis. The mechanism should be free from being affected by a worsening Covid-19 situation.

Include the following in your correspondence process to make it well-organized and stabilize your Revenue Cycle Management process:

• Patient and payer correspondence should be worked on a stipulated turn-around time irrespective of the gravity of the pandemic
• The correspondence workflow should include logging of all information pertaining to correspondence to the relevant patient ledger
• Develop the right set of action codes to bucket cases and even redirect them to the right employee for follow up with the patient or payer
• Automate the process of patient and payer information management and insurance correspondence so that critical correspondence can be flagged and prioritized

4)     Plug Loopholes in Denial Management

A robust denial management strategy helps providers maintain a steady cash flow. However, during the pandemic, the suddenness and magnitude of the outbreak, caused most denial management strategies to collapse like nine pins. Drawing on the lessons from the collapse, providers need to fine tune their denial management strategy to ensure it withstands the pressures of a resurgent variant.

Did You Know The average cost per resubmitted claim and reworked denials in 2021 was between $8-10. Likewise, the improper payment rate for Medicare FFS programs hovered around 9.51%.

Here’s what you need to take care of to stabilize your denial management process in 2022:

• Set up a team to screen all COVID-related denials. Also, separate denials based on COVID insured and uninsured claims.
• Likewise, have a special team to deal with telehealth denials. Like the last two years the flow of telehealth denials is likely to be faster.
• Bucket denials based on factors like amount, payers etc. Prioritize high value denials and assign it to members best suited to handle them or create special teams to deal with it.
• Focus on areas of risk-prone departments. 
• Ensure your denial teams stay closely in touch with payers. Be clear about expectations and follow up quickly if the amount received differs from the expected.
• Enable patients to enroll in an online financing plan within couple of months of  
  receiving care. Need be, provide consumers greater options in paying for their care.
• To deal with the possibility of staff shortage, partner with a denial management vendor. They have a ready team of experts to handle it for you.
• Fine tune a dispute strategy based on the lessons learnt from the pandemic; the strategy must define what needs to be disputed.  This will help streamline appeals.

5)     Build a Robust Follow-Up Program

A good denial management program will bring denials under control but cannot stop them altogether. Therefore, along with a denial program you need an equally strong follow-up program. Such a program infuses some discipline in collection efforts and stops the accounts receivable from growing causing things to slip out of hands.

The following best practices will help you have control over a follow up process:

• Record the approximate time taken by each payer to respond to a follow-up request and develop an action plan accordingly.
• Prepare the right action codes and link it to the promise date for subsequent follow-ups.
• Assign the task to particular team member and make sure they work with the payer till the case gets resolved.
• Establish a way to monitor the aging of responses. Have a clear matrix to identify and register all types of deviations.

6)     Effective Payer Contract Management

Like last year, healthcare providers are likely to face underpayment issues this year. The problem of payers reimbursing different amounts for the same service will persist. Therefore, this year too providers will have to manage payer contracts more effectively.  This means they need to be on their toes to dispute settlement issues with payers and back it with proper follow up to get reimbursed on time and in full.

The following best practices will help providers maximize their collections this year:

• Choose or upgrade to the best technology to upload and manage all contracts and agreed-upon fee schedules.
• Each of the contract terms for each payer must be entered in the process management software.
• Employees must be trained and tested completely on their knowledge of contract terms. This includes under or over-payments limits.
• Important contract information must be dissipated across the organization

Who We Are and What makes Us an Expert RCM Service Provider?

This article is brought to you by MedBilling Experts– a well-known rcm service provider with profound domain expertise. We have over 10 years of experience in handling the revenue cycle process requirements of some of the major hospitals in the US. These include medical billing, medical coding, denial management A/R management and so on. In the last two years our business continuity plan has assisted our clients insulate their practices from the shocks of the pandemic. Banking on our robust back-office processes they could ensure sustained cash inflow in the face of changing guidelines and severe staff shortage. If your business is looking to fortify RCM process in 2022, get in touch with us now.