Self-Pay Revenue Management

3 min read

5 Processes to Boost your Healthcare Revenue

March 27, 2019 - 6:22 PM

There’s a goldmine hidden within your billing processes but finding and extracting the extra revenue on your own can take time and resources that few organizations have – unless they have the right partners.

As a world class medical AR organization, we offer a lot of great revenue boosting solutions but we often find ourselves in the position to recommend companies who offer solutions that we don’t. So, in this article we’ll not only introduce you to some powerful revenue boosting solutions, but we’ll also let you in on some companies we’ve vetted and are proud to recommend.

Here are 5 processes you can implement immediately into your healthcare organization to quickly increase your revenue along with the companies that can help you achieve highly “net-positive” results.

Interim Staffing

Interim staffing is a crucial tool used by hospitals across the nation. Whether it’s a planned absence in a key management position or an unexpected gap from an increase in admissions, interim staffing agencies can help. To keep functioning when help is needed, hire from an experienced team that vets their candidates.

With experienced staffing– from C-level on down – your organization can continue to operate efficiently and reduce your cost per hire. That means no loss of momentum, no decrease in productivity and no deterioration in overall financial performance. ABLM is owned and operated by hospital CFO’s who know exactly what you’re going through. To learn more about how their staffing can help your organization, click here.

Denial Mapping, Trending, Recovery and Prevention

Healthcare reimbursement continues to decrease as healthcare grows. There are reimbursement opportunities within denials. Many hospitals have issues with denials, but they have a hard time determining how to prevent and overturn them. It’s important to regularly analyze denials data, review the categorization, and map denials appropriately to system actions.

C3 is a team of experienced healthcare professionals with the expertise to trend denials and determine areas of opportunity. Once the areas of opportunity are determined, they’ll collaborate with leadership and departments to design, implement, and monitor denial reduction strategies.

Authorization/ Financial Clearance Assistance

Authorization and Financial Clearance is another area of concern. Many hospitals are short-staffed and unable to fill vacancies causing incomplete tasks for example:

  • unreviewed benefits
  • unconfirmed out-of-network status
  • inability to obtain authorizations on all accounts

These incomplete tasks lead to increased denials and costly write-offs. In the past, payers would issue retro-authorizations for services that were medically necessary even though they were already rendered. Now, many payers will not issue retro-authorizations and will not pay claims without proper authorizations. Experiencing an increase in denials, write-offs and patient complaints about high out-of-pocket expenses causes a lot of pain for hospitals.

With C3’s hospital expertise, a team of experienced professionals can fill in your staffing shortfalls. You can choose to outsource a specific service line in your entire department or have us fill in any staffing vacancies.

Post Medicaid Eligibility

Your front office staff probably works hard to verify the patient’s insurance at the time of service. They may even assist self-pay patients with enrolling for Medicaid, but what happens after checkout? The time-consuming process of continually monitoring self-pay visits for eligibility begins. This is a daunting manual task that results in many billable opportunities going unnoticed and written off as bad debt or timely filing adjustments.

Scanning unpaid accounts is profitable--so profitable that many hospitals have started hiring this service out. Emerald AR Systems finds over 250K annually in missed Medicaid dollars for healthcare organizations. Emerald’s Claim Miner automated service scans self-pay accounts, identifying missed Medicaid opportunities. In addition to an increase in revenue, scanning unpaid accounts keeps healthcare organizations compliant and improves the patient experience. Through a process of data mining, patterns in the unpaid accounts can be identified and addressed.

Patient Collections

Most healthcare organizations use a collection agency to collect accounts turned to bad debt but very few healthcare-only collection agencies exist in the United States. Collecting healthcare debt is very different from collecting consumer debt such as student loans and credit cards. When healthcare collection agencies understand the billing processes in order to resolve patient billing issues, their collection approach is more patient-centric to enhance the overall patient experience. Healthcare collection agencies require sophisticated workflows to increase revenue and create task management systems to work with healthcare billing departments in resolving patient accounts.

What does patient-centric healthcare collections look like? Many hospitals have had success with:

  • revised paper statements that are easier to understand,
  • new digital patient portals to help patients check on their own bills,
  • multi-lingual staff and documents in areas with high linguistic variability, and
  • flexible payment plans, which can help to put the patient at ease.

These tactics create an experience that is tailored to the customer and has the benefit of also driving self-pay collections.

Emerald AR Systems, a healthcare collection agency based in Arizona, provides patient collection services nationwide to many large healthcare providers. Emerald’s professional healthcare customer service agents are trained to resolve accounts. Emerald has found that their patient-first collection approach leads to increased recovery.

Don't Wait--The Time Is Now

If your organization needs help boosting revenue, now is the time to start exploring your options. Schedule a 30 minute consultation with a healthcare revenue cycle expert today.

Audrey Cooper
Written by Audrey Cooper

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