by Ashley Choate
January 24th, 2018
According to a recent Physicians Practice study, one of the top five reasons for denied medical claims is a lack of adequate documentation. While this might seem like an electronic records issue, the problem may be bigger than that.
Imagine your practice as a series of cogs, each interlocking with one another to make the whole function as a unit. Each of those cogs represents a different department within your practice: medical, billing, front office, etc. Now, imagine those cogs are too far apart for the grooves in their gears to lock onto one another. Nothing moves, nothing functions, and nothing is accomplished unless each part works with the other.
Unfortunately, some practices are seeing this kind of disconnect within the work environment. Individual departments become buried under piles of work dictated by their own roles and fail to interact effectively with one another. When this happens, the whole office can suffer-especially your revenue cycle.
Few understand the importance of office communication in revenue cycle management (RCM). It's easy to consider the process of billing and collecting from clients to be a backroom-only kind of job, but it's not. The RCM process actually begins on the frontlines with office staff, then continues to medical interaction and documentation, finally falling on billing specialists to obtain funds where they can from insurance companies and patients.
Every step of the way, the practice as a whole contributes to RCM results and successes, from scheduling and treatment to patient interaction, documentation, and expectations. Below are some of the ways that your practice can improve office communication and achieve better overall revenue results.
Train Each Department on A/R
Billing, coding, and collections are complex processes within the medical field that take a lot of collaborative effort to manage successfully. Submitting for payment from insurers or managing patient payments can be especially difficult if
None of these are tasks the biller and coder, nor your business office or collections team, handles. The front desk, nurses, and doctors take care of most of those tasks.
In order for them to do it well, they need to fully understand how their actions contribute to revenue management. Front desk personnel need to be in the habit of verifying both insurance and contact information up-front for patients. According to a recent Modern Economics article, doctors and nurses also need to be knowledgeable about ICD-10 coding strategies and careful to indicate all the details of treatment and services provided so that insurers can be effectively billed, thus lowering the claim denial rate within your practice.
Identify Internal Disconnects and Find Solutions
Once everyone is fully cognizant of the role they play in RCM, it's important to start a method of two-way dialogue about what works and what doesn't. Physicians Practice recommends monthly meetings or online user groups for regular feedback and exchange. Opening these lines of office communication holds everyone accountable and encourages a solution-oriented approach to your RCM issues.
Encourage Interaction Through Technology
Other methods for opening up communication include adopting internal technology like instant messaging (IM) software, so questions can be quickly
Another tech-savvy option for increasing office communication is integrating your systems wherever possible and ensuring your electronic health records (EHR) software is as mobile and easy-to-use as possible. Making it easier for doctors and nurses to make notes to a patient's file also makes it more likely that they'll have the time to take care of it. Those notes could mean the difference between an accepted claim and a denied one, so the easier it is for doctors and nurses to update files, the better.
Revenue management begins as soon as the patient schedules an appointment, through effective insurance verification and data input. From there, when the patient comes in for a visit, front office staff needs to be sure to take copays and discuss payment arrangements prior to treatment. Doctors and nurses must be aware of the role their patient record notes play in the billing process. In short, everyone should be involved.
According to a Healthcare Financial Management Association publication, creating a
Don't let RCM become undermined by poor office communication. Build a culture of cooperation and effective revenue management within your practice by implementing