5 Key Areas to Deliver Healthy Collections Results

by Tracey Nelson

Healthcare is just as much about practicing preventive than reactive medicine. That’s why you undergo an annual physical check-up — to obtain an assessment of your overall health as well as remedy issues that could become more problematic later.

The same can be said about your organization’s financial health and your accounts receivable strategy and processes. Check-ups today ensure better performance tomorrow. Here are five critical monitoring areas that providers should have in place in order to significantly affect the quality and productivity of your AR well-being.

1. Intake, eligibility, prior authorization, denial management process documentation, training and testing

It’s amazing how many issues are prevented with the right attention at the beginning of the process. If handled early, well, and fully, you won’t have to go back later and clean up issues that could have been avoided. Revenue cycle management is a process that is highly dependent on each level working as accurately and smoothly as possible or all sorts of complications arise.

Since the best time to acquire accurate information is when the patient walks in the door, it’s essential that your staff is doing the right things, at the right time, and at the right level of effectiveness to prevent failure further down the line.

In my history, providers have 80% of their staff focused on collections and denial management activities and are often at the back end of the process. That’s backwards and very costly because it addresses issues from a corrective instead of a preventive mindset. When eligibility is in the back end of the process and disconnected to the staff taking orders, it may take months to detect and correct a problem, resulting in lost opportunity to collect, prevent further loss, and improve cash net return.

Key questions: How are you ensuring that the right people are handling the right things at the right time? Do you have adequate policy and procedures, thorough training and a mechanism to identify issues quickly?

2. Patient payer mix

Just as having the wrong staff in the wrong positions – the wrong employee mix –

sabotages your work’s overall effectiveness and revenue received, not having a solid understanding and up-to-date knowledge of your payer mix will stifle your AR health and productivity.

With the vast complexity and detail involved with healthcare records today, it’s not uncommon for you to be unaware of updates a payer made to their plans. If you don’t have a good surveillance system, good internal communication, and an early warning mechanism at the line/daily staff level, issues are bound to arise. Your team needs the tools and knowledge to handle these changes.

Your contracting strategy will drive your change in payer mix, and thus your change in payment rate. Monitoring on a continual basis will tell you how you are trending from a payer mix perspective. By monitoring on at least a quarterly basis, you can determine if your payers are abiding by contracted rates.

Key question: Do you have measures in place to monitor changes to your payer mix accurate and ensure adherence to these contracts?

3. Overall process flow and utilization of technology/workflow

This is crucial from a monetary and workflow basis because if you don’t have good workflow tools and processes, your claims may sit – either with a denial status or no status at all – and no one we be working the claim.  There is no single system that will show you ‘at a glance’ where claims are, which ones are lost in the system, and which ones are not being resolved in a timely manner. Since every payer has a timely filing provision, if you don’t have smart tools and highly skilled resources to escalate and address these claims prior to this timeframe, you have very little hope of recovering that cash.  Seems simple, but my experience is that providers don’t focus enough skilled resources to prevent leakage. 

Oftentimes, providers get stuck with a certain set of measurements that don’t tell them what issues are critical with their client base. Unless you have solid policies and procedures and are auditing gaps in your processes, leakage will be created from a revenue or cash perspective.

Tools are available for measuring staff downtime, and staffing capacity modeling can show organizations how many people they need, even including variations within the month. There are also metrics to demonstrate how much time is lost throughout the organization. The essential thing is that staff know what to do on a given day and they do it efficiently, without losing time shifting priorities too frequently.

Key question: Do you have tools that show you how effectively and efficiently your staff and processes are functioning?

4. Security and compliance

You can’ have a conversation about healthcare best practices and policies without discussing security, privacy, and compliance. Many a company has failed not because of personnel, passion, or purpose but because of inept or inadequate management in these areas.

The good news is that there are many tools to ensure that patient data is secure. A simple visual office walk-through can give you a good indicator on proper adherence to required standards. If you dig deeper, you can quickly see if providers are taking patient records and data seriously or not.

With compliance, most companies believe that being “good enough” in these areas is good enough. It’s not. Good intentions don’t always translate into properly fulfilling compliance requirements. Diligence, consistency, and accountability are required because even minor violations can cause serious damage to your company’s effectiveness and reputation, from which it may never recover.

Key questions: How confident and equipped are you to keep your data private while meeting compliance requirements? What controls do you have in place to ensure claims are filed accurately and with the supporting evidence?

5. Internal communication and culture

It’s very difficult for organizations to conduct an objective assessment on themselves — to “grade their own paper.” As a consultant, I have the advantage of objectivity, not to mention the tools and perspective to know where key common inefficiencies can be found.

After years of assessing organizations, I’ve found that most organizations are heading in the right direction, they just need tweaks here or there to see significant results. Many of the changes that turn into big results have to do with the things all companies can practice: good communication, clear objectives, a healthy culture, and a team approach.

Of course, change takes time and the right mindset from everyone involved.  And change isn’t easy. The optimal project plan includes effective communication and change management measurements to find out how things are progressing. Once employees see the positive impact, they’re more likely to jump on board and work with the new system.

Key questions: How committed is your organization to effective internal communication and building a strong corporate culture? Does your leadership team demonstrate this commitment in unity?

You wouldn’t neglect a check-up regarding your physical health for a year or two or three. Treat your company’s financial health with the same respect and attention. Make sure the right people and processes are in the right places and you’ll operate at top efficiency and profitability. The fate of your entire company and your team members depends on it.

Tracey Nelson is CEO at RCM Dynamics, a Dallas-based firm that delivers meaningful results for healthcare providers by reinvigorating their revenue cycle management processes, team, and technology. Their services are customized to client needs and include full analysis of RCM process and results with recommendations and a roadmap for improvements, targeted projects to eliminate backlogs while implementing preventive measures, and interim leadership and assistance with organizational design and role optimization. You can find more about RCM Dynamics here.