In today’s world of shrinking reimbursements, centers are looking for ways to decrease costs without sacrificing efficiency. By automating functions and tasks in the business office, facilities can reduce staff costs while also increasing efficiency. The list below represents a list of functions that Regent centers employ to achieve gold-standard revenue cycle metrics:
Insurance Verification. Automating insurance verification is nothing new – more than a decade ago facilities were accessing payer websites to verify patients’ benefits. Today with the integration of clearinghouses and management information systems, it’s possible to obtain up-to-date insurance information in seconds. At our centers, employees are able to obtain instantaneous, up-to-date insurance benefits populated right into patients’ charts in HST Pathways via ZirMed. This can be done either in batch mode or individually.
Scheduling. Several Regent centers use an automated scheduling system, decreasing the number of registration errors and increasing efficiency. SCOR Technologies offers a product that allows physician offices to view the ASC’s OR schedule and request appointments. Once accepted by the ASC, the patient information automatically populates in HST. Other home-grown electronic scheduling systems are in place at other Regent centers as well.
Claims Processing. Today nearly all facilities send their claims electronically, however, gold standard facilities setup customized edits with their clearinghouse to catch erroneous claims at the time of submission instead of waiting 30 days for an insurance denial. This process will help reduce Days Outstanding.
Payments. Most payers are able to send electronic payments directly to a facility’s bank account through electronic funds transfer (EFT). Your funds will be available more quickly and the chances for fraud are reduced.
Remittance/Payment Posting. Along with EFT, the majority of payers are able to send patient remittance electronically (ERA). Once centers have setup ERA, they can begin posting their payments electronically via Auto-Post. Auto-Post eliminates the timely keying of each individual payment thereby reducing key-stroke errors and increasing efficiency. HST allows the payment poster to approve each individual payment prior to auto-posting payments. This allows for greater flexibility with incorrect payments.
Contract Upload. Regent centers upload all payer contracts into HST. So at the time of posting, the payment poster can instantaneously verify whether the payment is correct and if not, flag it for follow-up. The uploading of the contracts also allows management to run an end-of-month Contract Variance Report to track insurance underpayments and determine if trends exists. These trends can lead to developing clearinghouse edits to prevent insurance denials.
Statement Generation. Gone are the days where centers take an entire day or half-day to print statements, stuff envelopes, affix postage and mail statements. Regent centers upload the patient statement files weekly from HST to ZirMed, which processes the patient statements for a price less than the centers could do it themselves. ZirMed statements look professional and can contain the facility’s information and/or logo.
Reports. For centers without a customized reporting package, some of the canned reports from the management information system may need to be modified from time to time. If you’re constantly performing the same modifications to reports in Microsoft Excel such as formatting and calculations, you can automate this process in Excel by developing macros. Macros have saved staff time at our facilities. For example, one facility was spending an inordinate amount of time each morning formatting scheduling reports for specific doctors. We developed a macro that reduced the time to format a report from 20 minutes to just one key-stroke.
Along with automating functions, the working of revenue cycle tasks can be automated, provided you have a robust management information system such as HST. Worklogs can be used as a type of “checks-and-balances” system for revenue cycle staff. For example, by setting up a task for CHARGES NOT ENTERED, a biller will be able to check his/her worklog daily to ensure all charges were entered. Utilizing a worklog will also make staff more efficient and cut down on the amount of paper an office uses. Most Regent centers utilize the Accounts Receivable tasks such as NO PAYMENT RECEIVED FROM PAYER, and PATIENT HAS NOT PAID FOR 30, 60, 90…DAYS SINCE LAST STATEMENT. Standard operating procedure is to print out an A/R report and work it line by line. The problem is that the report is out-of-date by the time the staff member gets to the bottom of the first page due to payers and/or patients paying subsequent to the report being run. The worklog is updated nightly so it is never out-of-date – staff will always be working receivables due. Management is also able to run worklog reports to track staff efficiency.
By automating both revenue cycle functions and tasks, facilities can improve their bottom lines without negatively impacting productivity.