Preventing revenue leakage from registration to billing

Revenue leakage, like a slow but constant drip from a hidden water pipe, accumulates over time to steadily erode margins. Fortunately, there are patient access automation tools that boost visibility into the top patient data errors that cause denials. This article explains how to simplify the new frontier of payer reimbursements by mitigating denials at patient intake, avoiding write-offs, and collecting more of the revenue you’ve earned. We’ll cover the following essential elements of reducing revenue leakage, including:

• • Leveraging insurance discovery
  • Enhancing the patient experience/access
  • Reducing claim denials
  • Improving workflows and reducing administrative burdens

Capturing essential data by leveraging insurance discovery

Revenue leakages can occur during the patient intake stage when patients don’t have insurance information with them when they arrive for care. Patients may even be unconscious during emergency situations.

This can cause you to write off items when you are not able to gather correct insurance information. That’s where insurance discovery software comes in.

“Insurance discovery is not just insurance verification. Insurance verification is really about validating what you already know,” says Kem Tolliver, President of Medical Revenue Cycle Specialists. “Discovery is something totally different. It’s going out and capturing information that you didn’t have before.”

“Through the Insurance Discovery solution, you’re able to use just a couple of key demographics from that patient. First name, last name, date of birth, social… you don’t need all of them,” says Philippe Vendredi, Inovalon Vice President of Sales.

With so much virtual care delivery these days, you often don’t have a patient in front of you, so coordinating benefits can be a challenge. You may not know the primary, secondary, or tertiary payer, which can leave you with incomplete eligibility information during the virtual encounter.

That also leads to the inability to pull necessary insurance data during a telehealth visit. These are times when revenue leakage isn’t the patient’s responsibility. If it’s a coordination of benefits non-payment, you can’t send that to the patient. It’s up to you to find that insurance, whether it’s through a better workflow within a software application or better communication with your patients – often, the best approach is a combination of the two.

Enhancing patient access by improving the patient experience

A better billing experience ultimately leads to a better patient experience. But every healthcare organization is unique in the way it conducts business. Instead of working with a vendor who sells you an out-of-the-box solution, it’s better to find a technology provider who is truly a partner. A partner takes the time to listen to your needs and develop a unique solution that makes sense for the way you do business. This, in turn, will ultimately improve patient care.

“A partner will work with you not where rev cycle is today, but where it’s going,” says Derek Shaw, President of Invicta Solutions. “More importantly, they’ll listen and go to work to create a solution for you. It’s obvious that’s a big part of the culture at Inovalon.”

Improving your billing processes can dramatically improve patient convenience.

“We’re trying to give our patients the easy button and just taking the barriers out of the way and letting them get the care that they need and getting on with their lives,” said Tolliver.

“We’ve done a really…great job of addressing that patient access side of the equation this year with the adoption, and evolution of Registration Quality Assurance which ties in our Insurance Discovery solution with some address verification functionality…as they [the patient] come in the door,” says Vendredi.

Reducing claim denials

You are probably aware that improving insurance verification is another opportunity to reduce denied claims. If you’re getting denials without coverage or the patient’s coverage is expired, you need to know whether the patient has any other coverage that can be applied.

Each payer has rules for smooth first-pass claim acceptance. Missing or inaccurate information is a frequent cause of claim denials. Your staff must confirm that patient and medical data, demographics, and required signatures are on file. Data points must be precise to match specific payer rules to avoid adjudication issues during submission.

Other reasons for claim denials include coding errors, benefit maximums being reached, medical necessity issues, and provider network constraints. However, according to a survey from the American Hospital Association (AHA), one of the most frequent reasons for claims denials was lack of prior authorizations.¹

Providers should focus on improving documentation on admission and throughout the patient’s entire stay. Knowing payer rules and tagging problem claims before submission will help.

Denials can also occur because of duplicate claim submissions after a provider resubmits a claim either on paper or electronically for a single encounter. Their inability to track previously transmitted and pending claims causes multiple filings and wasted resources.

Improving workflows and reducing administrative burdens

Do you have manual processes throughout the revenue cycle? Do your billers touch every single claim that goes out the door? Without insurance verification and clearinghouses for clients from coast to coast, properly processing claims can be a challenge. Think back to when your staff was working on green screens for Medicare, and you had to remember what operation every function key performed. Inovalon’s Claims Management Medicare Pro has vastly improved this process by providing a user-friendly interface that is much more intuitive than function keys and green screens.

“It’s very challenging for new employees to learn the old DOS system that Medicare still uses,” says Marco Ochoa, AR Manager, MGM Healthcare. “I had never found another system for getting into the Medicare website, but Inovalon has a solution that’s amazing. We can work the claims with our mouse and increase efficiency.”

Insurance verification is another obstacle that the right technology can help providers overcome. “One of the solutions that I’ve been able to leverage with Inovalon is the ability to incorporate insurance verification directly into claims batching,” says Tolliver.

One of the most inefficient workflows, and a source of revenue leakage, is the prior authorization process. It is often at the root of hindering your ability to get paid for services. However, technology is not always the sole solution.

What is often needed is updated legislation to help solve this thorny problem. You need to let legislators know the challenges you’re faced with and some of these administrative burdens that could be solved through policy changes.

“It’s great that we can solve some of these inefficiencies through workflows and automation, but there’s also an advocacy component,” says Tolliver.

Finding ways to remove some of those manual, repetitive processes will help your staff’s experience. Today’s healthcare organizations have difficulty recruiting and retaining staff. So, making their experience as easy as possible is one of the key solutions to employee retention, in addition to reducing revenue leakage and making sure you collect everything that’s owed.

Address revenue leakage and improve RCM performance with Inovalon

A lot can happen between providing service and receiving payment. By employing the four strategies discussed above, you can take great strides toward improving your processes and minimizing revenue leaks.

At Inovalon, we help healthcare providers do more for their patients and their bottom line through automation and analytics that enhance efficiency and claims accuracy. Discover how Inovalon can streamline your billing processes, revenue cycle management, care quality, and workforce management, through the Inovalon Provider Cloud.

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Source:

1. “Hospital Claim Denials Up for Most, Driven by Prior Authorizations,” Jacqueline LaPointe, RevCycle Intelligence, December 8, 2020, https://revcycleintelligence.com/news/hospital-claim-denials-up-for-most-driven-by-prior-authorizations

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