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Improve your revenue cycle IT infrastructure

Patient Access Weekly Advisor, September 19, 2007

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Because of the recent shifts from inpatient to ambulatory care, increased claim denials, and the growing volume of small dollar accounts, savvy directors are making the transition from labor-intensive processes to highly automated processes.

The best performing revenue cycle departments use information technology (IT) systems to ensure that they bill claims accurately, in a timely manner, and in accordance with third-party payer regulation. They use add-on systems to reduce upfront rejection rates and decrease third-party denials. The revenue cycle is extremely complex and the potential for errors is high, because the average hospital processes hundreds of thousands of transactions each year. Many patient accounting departments are also trying to cut administrative costs, but without proper technology, breakdowns will occur.

Consider doing the following when assessing information systems:

Implement electronic verification. This is a fast growing application that allows providers to quickly identify coverage issues as opposed to spending time calling payers. Good insurance verification systems go directly to the payer's Web site to electronically obtain insurance eligibility, and then automatically post that information to the patient accounting system. Online eligibility helps decrease denials and secures service reimbursement.

Automate the ABN process. Manual screening processes create massive medical necessity write-offs. Good ABN software screens for medical necessity on the front and back end before you submit claims. If you use this system properly, you can have 100% Medicare compliance when it comes to billing. If necessary, you can print a completed Medicare-compliant ABN form in less than a minute that is ready for the patient's signature and includes the estimated cost.

This tip was provided by Jim Yarsinsky, CPAM, president, Expeditive.

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