In this presentation, revenue cycle experts Brian Harris and Jess Stover will guide attendees through the steps every agency should take to optimize billing and collections workflows. Beginning with best practices and KPI tracking, we’ll examine how department structure and communication strategies are used to eliminate inefficiencies and create strong financial outcomes. Next we’ll take a look at how full or partial outsourcing can enhance productivity and add predictability to your agency’s cashflow. Finally, we’ll consider the anticipated regulatory changes ahead and discuss how agencies can best prepare their billing department for an uncertain future.

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
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