Intake: The critical revenue cycle point
Multiple factors pressure healthcare revenue stream
As with any important process, the healthcare provider’s revenue cycle has a distinct beginning – in this case it is the patient’s initial encounter. And it is at this critical juncture that providers must do everything possible to ensure that all the financial details are in order.
Recovering money lost at the intake step grows more convoluted and futile as time passes, financial experts say – a consequence that has grown more serious in a challenging healthcare economic climate.
“You need to capture and bill out everything you are providing service for – trap everything you can,” says Mark Isenberg, business development manager for Indianapolis-based Zotec Partners. “Over the past three years self-pay is the largest payer with health savings accounts and high deductible plans, which are stretching out the revenue cycle and allowing for more bad debt to occur.”
Radiology groups have seen reimbursement declines in recent years and “clearly have a target on their backs from CMS’ effort to reduce multiple procedures,” Isenberg said. Zotec is working with these clients to provide electronic audits on the front end to reconcile claims throughout the system. Any anomalies are flagged.
The company has also developed an outbound dialer that reaches out to patients notifying them of any unpaid charges. “The days of statement letters are pretty much over,” Isenberg said.
Orthopaedic Specialists of the Carolinas in Winston-Salem, N.C., identified intake as the primary source of its revenue stream, especially verifying insurance eligibility, said business office manager Regina Hayes.
The 23-physician clinic has four locations and sees roughly 700 patients each day – a volume that is 23 percent higher than last year, she said. Since adopting a web-based claims clearinghouse from Duluth, Ga.-based Navicure, the organization has developed an intake system that establishes each patient’s insurance status before services are rendered.
“Patients would come in with an insurance card that may or may not be valid and even though we had one FTE dedicated to checking out eligibility, it was impossible to catch everything,” Hayes said. “Ineligibility had a huge impact because many of our patients are surgery candidates – it is imperative to pre-certify their insurance status.”
Navicure has also helped the clinic maintain a low days outstanding level for its accounts receivable, which averages about 30 days, Hayes said.
“By working in real time, we know when the claim hits the payer and helps us get ahead of rejections and denials,” she said.