To optimize your Revenue Cycle Management process you should be able to first identify the loop holes. You past history is your gold mine. Analysing past claims and denials history will allow you to take fact based decisions. Blindly implementing best practices will not work as each facilities issues are different and hence taking a deep dive into the past history becomes extremely important.
A recent study indicated that over 80% of denials can be prevented but somehow they still occur. Some of these preventable denials include:
- Denials Due to Non Covered Services
- CPT DX Mis-Match
- Late Filing of Claims
- Denied due to Duplicate
- Missing or Incorrect Information in Claims
These are very easy to avoid. If you carefully study your past denial history, you will definitely be able to identify few patterns. Watch those patterns and identify why they are occurring. You might find few denials that are not mentioned above. However, the analysis will give you an insight on what's going on with your RCM. Implement standards and best practices once you have identified the patterns.
A simple way to identify the major contributors to the loss of revenue is to do a comparative analysis between each denial or any issue that you would like to measure. Below are few steps to follow:
- Classify the data (Example: Bucketing each scenario into a denial bucket)
- Measure the occurrence (Example: Times its occurs or impact by $ value)
- Compare (Example: Put up a Pareto Chart)
Performing this simple exercise will give you analytics and business intelligence on the major draggers in your RCM. Once you have identified these patterns, implement automation or best practices that can help avoid denials. You might be very strong in Denial Management. But we believe Denial Management is "Patch Work" and not a permanent solution as you are working on rectifying and resubmitting instead of avoiding issues in future. Whereas analysing past history will allow you to attack the root cause and find a "Permanent Solution" to Optimize your Revenue Cycle Management.
Sounds simple but it can get overwhelming to perform this activity. You can consider outsourcing RCM Optimization. Promantra has extensive experience in streamlining Revenue Cycle Processes and looks into each identified issue thoroughly to find a solution that can have a visible impact and improve financial outcomes. Promantra's experience in RCM, and ability to build RCM automations to contain revenue leaks have helped various organizations achieve better results in RCM. Contact Promantra today to streamline your RCM Process.
So here's the question your should ask yourself or your RCM staff. Are you doing Patch Work or finding Permanent Solutions?
In case you have challenges streamlining your RCM Contact Promantra Today.
VP - Corporate Communications