The revenue cycle is the process by which healthcare providers receive revenue for their services. A revenue cycle typically starts when a patient arrives at the rehab facility and ends when the facility gets full payment for services rendered. Efficiency in revenue cycle management focuses on creating a seamless flow and integration of the various stages of the cycle. An organization with an efficient revenue cycle management system improves its bottom line and creates a competitive advantage in the industry. Here are the five stages that seek to enhance efficiency in a revenue cycle of a rehab facility.
1. Pre-Authorization and Eligibility Verification
Eligibility verification is the first stage of the revenue cycle. At this point, the patient details regarding their insurance coverage and eligibility are collected and verified. The pre-authorization and eligibility stage forms the foundation of a clean claim. Without proper verification, your organization may lose revenue or experience challenges reworking the claim. Besides, the facility may offer services but leave the revenue on the table. An efficient pre-authorization and eligibility phase ensures patient balances and coverage status are collected from the front end to provide insights into the reimbursement process. Efficiency in this stage benefits your organization through;
- Submission of clean claims
- Minimizing resubmissions
- Reduced of denials
- Increased upfront collections
2. Services and Charge Capture
After completing the pre-authorization and eligibility verification process, the patient can receive services. After rendering the services, your facility should transcribe the services rendered into billable charges. Charge capture involves assigning a medical code to claim reimbursement for the services rendered. Errors at this stage can cause an enormous loss of revenue. An efficient process identifies and addresses leakages and mistakes that may lead to revenue loss.
Most delays and denials originate from this stage. If your staff assigns wrong codes to services rendered, you risk spending valuable time reworking the claims.
To enhance efficiency at this stage, an organization should provide regular training sessions for their billing staff and invest in technology to automate the process. Technology like the electronic health record (EHR) systems minimizes errors and time wastage.
3. Claim Submission and Denial Management
The third stage of revenue cycle management is the submission of claims. It comes after an efficient eligibility check and charge capture processes. However, that does not mean you will always have clean claim submissions. Sometimes errors are inevitable no matter how well you train your billing staff. Technology and staff collaboration can help enhance efficiency in this stage, but a billing partner provides a comprehensive solution. Further, a billing partner enables real-time claims tracking to allow error detection and corrections before denials.
4. Receiving Payment
The payment stage involves receiving payment for the services rendered after verification and approval by the patient’s insurer. In addition, you also receive out-of-pocket from the patients at this point. You can enhance efficiency at this stage by offering regular training sessions to your staff and investing in technology. Through technology, patients can log into a patient portal, view their bills, and make payments. Efficiency at this stage optimizes your cash flow management by eliminating delays and denials. An efficient revenue cycle management system also optimizes medical debt recoveries.
5. Report Generation
The last stage of an efficient revenue cycle is report generation. Organizations have a lot to learn from quality reports. Revenue cycle reports allow an organization to assess its performance, identify trends in the industry and eliminate snarl-ups. Technology is one of the best ways of enhancing efficiency in reporting. Billing partners that apply technology, for instance, simplify and integrate data for comprehensive reports that are easy to retrieve. You can also use their dashboards to identify areas that need attention before the reporting date.
Complexities in Revenue Cycle in Rehab Facilities
While organizations seek to enhance efficiency in revenue cycle management, complexities in rehab facilities may derail this vision. Here are some issues that may impact revenue cycle management in rehab facilities.
Insurance providers like Medicare have specific regulations that a facility must meet before reimbursements are approved. In addition, the rules are reviewed from time to time, which makes it difficult for rehab facilities to submit clean claims. An organization that does not have billing experts may face constant denials and delays in reimbursements.
Verification is an essential element of revenue cycle management. Organizations must have elaborate verification criteria that check all the details that may impact the reimbursement process.
Insurance providers have different policies tailor-made for specific covers. Their policies may have high copayments and coinsurances. Rehab facilities may require experts to help them understand the various insurance policies.
Like the insurance providers, third-party payers have different reimbursement timelines. An organization must submit claims within stipulated timelines to avoid delays or denials. Rehab facilities that have not automated their revenue cycle may experience challenges with third-party payments.
Rehab facilities are required to use specific codes for different services rendered. Facilities that do not have coding experts face constant delays and denials due to coding errors. Most facilities may, therefore, require hiring coding experts.
Enhance Your Revenue Cycle Management with Logik
Rehab facilities risk losing revenue, experiencing claim delays, or denials if they do not enhance efficiency in their revenue cycle. The facilities also face reporting challenges when they use conventional methods of revenue cycle management. Errors in the verification and charge capture stages can cost the organization thousands of dollars in lost revenue.
While technology and staff training may solve some of the complexities, rehab facilities require more than RCM software. Managed billing providers like Logik are the real game changers. Logik has invested in the technology and personnel needed to streamline your revenue cycle management and eliminate leakages, delays, and reimbursement denials.
Do You Desire an Efficient Revenue Cycle Management Partner? Contact Logik
At Logik, we understand the unique features of rehab facilities and the challenges in their revenue cycle. Our experienced team focuses on enhancing efficiency in your revenue cycle by streamlining your verification, charge capture, claim submission, and reporting. Our services eliminate leakages, increase revenue, and create a competitive advantage for your organization. Schedule a demo today.