Accelerate Collections Archives – Spark Health Partners

The Ultimate Guide to Revenue Cycle Assessments

Ryan Goodin — Mon, 08 Jul 2024 20:50:00 +0000

How to determine if an RCM assessment is right for you and how to select the right partner. … Read More

The post The Ultimate Guide to Revenue Cycle Assessments appeared first on Spark Health Partners.

Operator Insights: Unbilled Management

Ryan Goodin — Mon, 12 Jun 2023 22:31:43 +0000

Expert insight on why centralized unbilled management is key to revenue cycle success. … Read More

The post Operator Insights: Unbilled Management appeared first on Spark Health Partners.

How to Avoid the Top 4 RCM Issues Impacting Your Bottom Line

Shannon White, Chief Operating Officer — Fri, 12 May 2023 12:00:22 +0000

With 1 in 3 hospitals expected to continue operating with a negative margin, leaving money on the table isn’t an option. But it’s a billion-dollar issue.

We’ve found more than $1.1B left on the table across 36 healthcare organizations through in-depth assessments of revenue cycle operations in the past four years alone.

Here’s where we typically find the biggest financial impact and revenue cycle issues within the healthcare industry, regardless of an organization’s size:

01 Denial Recovery

Every organization is faced with denials, but not many have mastered the art of identification, recovery and prevention. The result? Avoidable lost revenue.

Problem: Lack of visibility, expertise + specificity

Some organizations lack the ability to map denials and separate them from contractual adjustments, preventing them from being tracked and trended. We see organizations where the biller is responsible for denial follow-up, where clinical teams aren’t engaged to support appeals, where appeal letters are written globally instead of specifically addressing a denial reason — the list goes on.

Without fundamental visibility into denial volume and specificity in the appeal process, avoidable write-offs keep piling up and potential revenue keeps getting missed.

WHAT IT WAS COSTING OUR CLIENTS: >$400M EACH YEAR

Solution: Dig into the details

The first thing to do is make sure you are accurately mapping and tracking denials instead of masking them as contractual write-offs. Does the 835 match up to the contractual adjustment?

Once you’re confident you know where your denials are coming from, ensure you have dedicated resources in place to properly monitor and appeal them. Engage the right clinical and medical billing experts to increase your overturn rate and provide upstream teams with training on denial trends and ways to reduce claim denials to prevent future issues.

02 Unbilled Management

Decentralized unbilled management leads to costly delays in revenue and is a problem that starts the minute the patient walks in the door.

Problem: Decentralized ownership

We often find providers don’t have centralized management of their unbilled accounts. The billing team thinks it’s a coding responsibility, the coding team thinks it’s a registration issue, and so on.

No centralized ownership of unbilled management means no centralized visibility into unbilled edits needing resolution and no shared accountability to get them resolved, further contributing to revenue cycle issues.

WHAT IT WAS COSTING OUR CLIENTS: >$290M

Solution: Collaborative unbilled management

Ensuring claims go out accurately and on time is the responsibility of the entire revenue cycle team and requires collaborative management of the whole process.

A registration error can lead to a coding edit, which can lead to system edits, all of which have the potential to delay the bill. Establishing a multidisciplinary team to monitor all unbilled accounts, assign ownership and accountability for resolution, and track action items drastically accelerates revenue.

03 Pre-Service Collections

Research shows healthcare professionals only have a 30% chance of collecting on a patient balance after the patient walks out the door. So why is it so difficult for providers to collect upfront? Many hospitals struggle with the myth that discussing patient financial responsibility prior to service diminishes the patient experience. But, in fact, it has the opposite effect.

Problem: Unequipped patient access staff

We work with clients who believe pre-service collections aren’t possible because of the type of facility or service they provide, like long-term care or pediatric oncology, or because it doesn’t align with their culture. Combined with the misconception that asking for money is a bad thing, many hospitals fail to equip their front-office staff with the tools and training needed to effectively talk with patients about financial responsibility and offer ways to collect a balance.

WHAT IT WAS COSTING OUR CLIENTS: >$250M

Solution: Tools + training to collect with empathy

The reality is 80% of patients want their doctors to help them manage financial responsibilities by clearly communicating what insurance covers versus what they owe. Equip your patient access staff with scripts, job aids and software to adequately support these conversations without diminishing the patient experience.

Discussing financial liability upfront helps patients feel more informed about their financial responsibility in advance rather than being contacted after the fact and left wondering how they can go about settling outstanding balances. It also creates opportunities to connect to financial aid, determine eligibility for discounts, research applicable insurance coverage and set up payment plans, if needed. It can add certainty and peace of mind in an otherwise uncertain circumstance, which can be a huge relief to patients regardless of the facility they’re in or the type of care they’re receiving.

04 Coding Validation

A recent study showed one-third of healthcare reimbursement experts report coding errors as the major concern for denials. One wrong code could lead to significant delays in revenue, missed opportunities for reimbursement or risk for overpayment recoupment.

Problem: Manual coding review

Either no internal audit team is in place (yikes!) or a small group of coders and CDI specialists are tasked with selecting a certain sample of accounts, reviewing the coding and documentation, flagging any errors and extrapolating results.

So why is manual review an issue? Because nearly 40,000 individual codes would need to be reviewed each month for a hospital seeing 900 inpatients and 4,250 outpatients. That volume alone would require six skilled auditors performing nothing but reviews every month to validate the accuracy of 100% of accounts. Even if a hospital could staff a team of experienced auditors solely focused on account review (which most can’t), human error would still be an issue.

WHAT IT WAS COSTING OUR CLIENTS: $132M EACH YEAR

Solution: Automate your audit

Leveraging technology to audit 100% of accounts and validate all codes eliminates human error and prevents the risk of undercoding or overcoding. This ensures the associated revenue is accurate and the claim has a higher likelihood of being paid on time.

Think your metrics are stable? Suspect you may have a performance gap? Or maybe your root cause issues are unknown? An operational assessment every few years can help pinpoint areas of strengths and weaknesses across your revenue cycle management processes to prevent costly mistakes and alleviate margin pressure.

Remember, just because your KPIs are green doesn’t mean there aren’t any underlying revenue cycle issues costing you money you probably can’t afford to lose.

If you’re ready for a thorough assessment and detailed action plan for resolution, contact our team today.

Get the latest insights

Spark’s monthly newsletter keeps you ahead of the curve with unique perspectives and actionable insights about the issues at the top of your agenda.

The post How to Avoid the Top 4 RCM Issues Impacting Your Bottom Line appeared first on Spark Health Partners.

10 Tips for Managing Your Hospital Billing Watch List

Andrew Ray, SVP, Operations Excellence + Innovation — Thu, 18 Aug 2022 17:17:46 +0000

During Epic implementations, system assessments and optimization projects, we frequently find the Epic watch list section of the hospital billing overview dashboard is missing accounts, creating an Epic “black hole.”

This happens when clients set up their Epic system and stop certain accounts from appearing in the workqueue and on the work list, which leads to account neglect and lost revenue.  

When optimized, the watch list can be a valuable tool for revenue cycle managers. Is your hospital billing watch list neglected?

Here are 10 tips to optimize your Epic watch list:

1. Review and fine-tune your watch list criteria shortly after your initial Epic go-live. 

First, make sure accounts route to workqueues appropriately. Next, add filter rules to prevent false positives from showing up inflating numbers on the watch list. For example, the “Outstanding Ins Not on WQ” check will identify accounts that are not on a workqueue 30 days after a claim was sent. But, if you have certain accounts with an intentionally longer follow-up period, like 45 days, then add a filter rule to prevent these account types from unnecessarily showing up on the watch list too soon. Also make sure you aren’t over filtering and inadvertently excluding accounts.

2. Check your “holding workqueues” to make sure you’re not hiding any problems or neglecting accounts.

If holding queues or filter rules exist solely to stop accounts from routing to the workqueue and showing up on the watch list, they may never be worked by an associate or a vendor – consider eliminating them to avoid this problem. One of our clients had hundreds of accounts in a holding queue that no one was working, which greatly impacted their revenue.

3. Build custom watch list alerts to supplement the standard watch list checks.

For example, add an alert to identify credit balance accounts not on a workqueue – always make sure this alert is actionable by the group using the watch list and there is a workflow in place so the team knows how to process them. We’ve seen many clients with custom alerts to identify accounts nearing timely filing or discharged not billed (DNBs) over a certain dollar threshold, but they never established a process to address the accounts that show up, which led to neglect. These account types can also be addressed via workqueue monitoring and workqueue prioritization.

4. Assign owners to each metric on the watch list to support accountability.

Additionally, review metrics’ trends weekly, but switch to daily reviews when there’s high volume. Ownership should also be documented outside of the system. We typically see our clients assign the billing team to maintain the metric ownership document.

5. Use the watch list to help identify broken or potentially missing workqueues.

The watch list should alert you to issues that are not getting addressed. Build your workqueues to automatically identify and route accounts to the “accounts should be discharged” or “accounts should be billed” sections so associates can proactively identify and correct issues before accounts become neglected. 

6. Reassess the watch list criteria after upgrades.

Occasionally upgrades and associated automatic changes can cause accounts to disqualify for workqueues and show up on the watch list. As Epic has increased the frequency of upgrades, it’s important for both operations and IT teams to work together to ensure that the system’s build, such as the work list criteria, continues to support revenue cycle operations. 

7. Make sure you’re using all sections in the radar dashboard needed to monitor your accounts receivable (AR) to identify potential “black holes.”

We often find clients over-customize their dashboards but fail to add the most updated dashboard sections for AR monitoring. We recommend using the standard Epic-released dashboards as much as possible. Epic has committed to maintaining these dashboards and adding new sections with every release.

8. Find infrequently worked and neglected workqueues.

For those infrequently worked, use the hospital billing workqueue monitoring dashboard. And for neglected workqueues, use the hospital billing workqueue monitoring reporting workbench report, which can be exported to Excel for further analysis.

9. Establish a governance process including your Epic IT and revenue cycle operations teams for system changes impacting your watch list and workqueue structure. 

Our clients achieved a lot of success when they created an operations and IT governance partnership and produced SBARD (situation, background, assessment, recommendation, decision) documents to frame up the business requirements and rationale behind the build request. Additionally, they required signoff from key stakeholders and an oversight committee that helped ensure the requested change was truly necessary.

10. Create accountability and open communications for keeping your watch list clean involving both your Epic IT and revenue cycle operations teams

For example, if operations submits a request to exclude certain accounts from specific workqueues, they need to indicate the workqueue those accounts should be routed to. Likewise, if IT makes changes to exclude accounts from workqueues, they should also make sure those accounts are routed to another workqueue and share that change with operations. We’ve found that establishing this infrastructure up front helps to prevent a “black hole” and account neglect.

Is your hospital billing watch list neglected? Does your Epic instance need to be optimized to maximize revenue? We can help. We have more than 60 Epic experts with certifications across more than 130 Epic applications ready to help bridge the gap between your clinical, financial and revenue cycle teams. We leverage our experience across several different Epic instances to help take the guesswork out of redesigning and implementing new workflows that maximize your Epic investment.

Contact an Epic-certified expert today to see how we can help.  

Get the latest insights

Spark’s monthly newsletter keeps you ahead of the curve with unique perspectives and actionable insights about the issues at the top of your agenda.

The post 10 Tips for Managing Your Hospital Billing Watch List appeared first on Spark Health Partners.

How to Improve Collections + Enhance Patient Experience

Ryan Goodin — Wed, 01 Jun 2022 22:20:43 +0000

Tips for establishing a pre-service collection program that puts patients first. … Read More

The post How to Improve Collections + Enhance Patient Experience appeared first on Spark Health Partners.

Case Study: Establishing a Patient Collection Program

Ryan Goodin — Wed, 12 May 2021 22:26:34 +0000

See how Bon Secours Mercy Health improved collections with a patient-friendly program. … Read More

The post Case Study: Establishing a Patient Collection Program appeared first on Spark Health Partners.

Accelerate Collections Archives – Spark Health Partners

The Ultimate Guide to Revenue Cycle Assessments

Operator Insights: Unbilled Management​

How to Avoid the Top 4 RCM Issues Impacting Your Bottom Line​

With 1 in 3 hospitals expected to continue operating with a negative margin, leaving money on the table isn’t an option. But it’s a billion-dollar issue.

01 Denial Recovery

Problem: Lack of visibility, expertise + specificity

WHAT IT WAS COSTING OUR CLIENTS: >$400M EACH YEAR

Solution: Dig into the details

02 Unbilled Management

Problem: Decentralized ownership

WHAT IT WAS COSTING OUR CLIENTS: >$290M

Solution: Collaborative unbilled management

03 Pre-Service Collections

Problem: Unequipped patient access staff

WHAT IT WAS COSTING OUR CLIENTS: >$250M

Solution: Tools + training to collect with empathy

04 Coding Validation

Problem: Manual coding review

WHAT IT WAS COSTING OUR CLIENTS: $132M EACH YEAR

Solution: Automate your audit

If you’re ready for a thorough assessment and detailed action plan for resolution, contact our team today.

Get the latest insights

10 Tips for Managing Your Hospital Billing Watch List

Here are 10 tips to optimize your Epic watch list:

1. Review and fine-tune your watch list criteria shortly after your initial Epic go-live.

2. Check your “holding workqueues” to make sure you’re not hiding any problems or neglecting accounts.

3. Build custom watch list alerts to supplement the standard watch list checks.

4. Assign owners to each metric on the watch list to support accountability.

5. Use the watch list to help identify broken or potentially missing workqueues.

6. Reassess the watch list criteria after upgrades.

7. Make sure you’re using all sections in the radar dashboard needed to monitor your accounts receivable (AR) to identify potential “black holes.”

8. Find infrequently worked and neglected workqueues.

9. Establish a governance process including your Epic IT and revenue cycle operations teams for system changes impacting your watch list and workqueue structure.

10. Create accountability and open communications for keeping your watch list clean involving both your Epic IT and revenue cycle operations teams

Get the latest insights

How to Improve Collections + Enhance Patient Experience​

Case Study: Establishing a Patient Collection Program

Operator Insights: Unbilled Management

How to Avoid the Top 4 RCM Issues Impacting Your Bottom Line

1. Review and fine-tune your watch list criteria shortly after your initial Epic go-live. 

9. Establish a governance process including your Epic IT and revenue cycle operations teams for system changes impacting your watch list and workqueue structure. 

How to Improve Collections + Enhance Patient Experience