Takeaways:
- Collection efforts should make up the highest percentage of Billing Department time allocations
- Gather and document all available payor intelligence into a centralized payor matrix
- Establish process and KPI goals, and communicate these goals to the whole team
- Poor KPI trending could be the result of gaps in Revenue Cycle processes
- Aim to resolve claim issues in fewest possible touches
- Days to RAP will need to be lowered under 5 days if proposed RAP penalties are enforced in 2021.
- 2021 (proposed) RAP payment reduced to 0% and 2022 (proposed) implementation of Notice of Admissions at the start of care
- Coding/OASIS issues can result in high days to RAP, lower case mix and unpaid final claims
- Monthly cash goals should be based on prior months’ revenue and payor processing trends
- Clearly define roles and expectations for internal team and/or outsource partners
Recommendations:
- Align assignment of responsibilities of Billing Department tasks to individual team member strengths
- Perform all billing & cash posting electronically
- Perform cash reconciliation weekly at a minimum
- Set follow-up dates for outstanding claims based on payor processing time
- Develop denials tracking system to allow for issue quantification
- Optimize EMR and clearinghouse to increase clean claim percentage
- Communicate with the Intake Department and Pre-Bill Audit/Clinical Teams on unsigned orders, etc that are causing delays in billing
- Communicate with Finance for upcoming positive/negative impacts to the financials due to Billing & Collections
- Develop both short-term and long-term goals with Billing & Collection outsources
- Collection notes should include enough detail that someone unfamiliar with the case would understand progress