This is the time of year to open the windows, air out the house, deep clean long neglected spaces, and tidy up. For AR managers, it’s also a good time to “spring clean” the revenue cycle in a few key ways.

1. Update and refresh your payers’ contracts “wiki”. Likely, payer requirements have changed. Know the nuances. Reviewing the contracts and the summary sheet you’ve created for each to make sure your knowledge is current. Make sure your billing practices are consistent with payer expectations. You may think, “But my billing software should be up to date with all changes.” Not necessarily. You will discover that it’s always a good idea to check and to communicate disparities with your vendor. Some areas to focus on: 
   • Levels of care by RUG scores or service levels
   • The level of ICD-10 code specificity required
   • How many days are considered co-pay days
   • Which ancillaries are covered in the base rate and which may be billed separately or not at all
   • If a pre-authorization and re-authorizations for a stay are needed

2. Check the aging. Ask yourself, “Are our payers paying correctly?” Are they paying the contracted rates for ancillary services? The billing software may have it right, but does the payer? Reconcile what you are billing with the actual payments. If you don’t the ripple effect could be significant. A credit on your aging may not really be an overpayment. It may mean you are not tracking payments carefully. This involves more than just answering the question, “Did we get paid?” Instead, you should ask, “Did we get paid correctly and are you recording the payments correctly?

3. Revisit your pre-admission screening procedures. Confirm that the pre-admissions screening procedures cover all the financial bases before admission. This may sound overly simplified, but it is so essential because of the numerous moving parts.

4. Make sure the census is correct. This seems so obvious, but it is so critical. Make sure the census is up to date and entered correctly in the billing software.

5. Stay on top of your Days Sales Outstanding (DSO). Discuss DSO with your team. Evaluate your progress towards reducing it to an acceptable level – ideally around 30 days. Realistically identify what is in your control. For example, Medicaid in some states pay much later than others. Consider DSO carefully, set goals thoughtfully, collect aggressively, and review regularly.

6. Conduct a thorough claims triple check. This should be a multi-disciplinary review of all claims prior to submission. While it may not be practicable to review all claims, identify what could be a reasonable random sampling. You may want to target claims forwarded to a certain payer with which you have had problems in the recent past.

7. Engage the right clearinghouse. Reassess your clearinghouse. You need to be sure that:
   • It knows your business and post-acute payers
   • You see cash flow improvements quarter over quarter
   • Its application is robust with simplified, intuitive workflows
   • It generates accurate and actionable reports
   • That the application is truly enterprise class with single sign-on for ease of access to multiple facilities, especially for designated region and corporate staff
   • The clearinghouse support team listens and promptly responds to your concerns and requests

It’s time to open those windows and let the fresh air in.  Spring clean your revenue cycle. It just makes cents.

Bonus: Discover 5 tips for maintaining your revenue stream in 2016

Now would be a good time to get back to the basics, the essentials, of what a clearinghouse is and offers. “Clearinghouse 101” – an introduction to the some of the critical features and benefits of a claims clearinghouse. Whether you are using one today or not, take a peak. You may find some of the following tips and points useful.

One portal does it all

A clearinghouse becomes the one-stop shop, the aggregator, for all claims processing actions - all in one portal with a single sign-on to submit, respond to, monitor, and manage all claims submitted to Medicare, Medicaid, Managed Care, private insurances, and other 3^rd party payers. Within the portal, billers can make changes or corrections to the claims and have access to DDE, HETS, and claims-in-process.

A claims translator

The clearinghouse takes the claims created within billing software and should run them through a scrubber to make sure that they are compliant with each payer’s requirements. If the clearinghouse find errors, it notifies the billers which claims need what information. Once the clearinghouse verifies that the claims are complete and comply with the payer billing requirements, it converts them into a format readable by the payer and forwards the claims. As a link between the provider and its payers, in essence, a clearinghouse is a claims translator.

Not a billing service

Periodically, someone will ask us if we, a clearinghouse, are a billing service. The straightforward answer is, “No.” A clearinghouse works with a provider's billing service/billers to complete the revenue cycle and to get cash back in your hand.

A convenient tool to monitor, manage, and follow-through

Submitting the claims is one thing, monitoring and follow-through are another. The clearinghouse portal enables you to see into what is happening with the claims once the payer has accepted them. Through the portal, billers can view the entire lifecycle of the claim and take action as needed to keep the claims flow steady.

Create secondary claims automatically

Please refer to this blog to learn more about how a clearinghouse should help to process secondary claims automatically and timely.

Claims data storage

Our clearinghouse, for example, securely stores the data up to 10 years, retrievable for the provider at any time.

Support

Experience and expertise are the foundation of a responsive and reliable support system. A clearinghouse can identify what is acceptable and answer claims submissions and processing questions.

Reports

A clearinghouse should have a core set of useful reports to help billers, their managers, and the executive team to track and trend the claims cycle. The reports offerings should help providers to track their billers and claims.  

The bottom line

From a benefits point of view, what does a clearinghouse offer?

• Simplicity - An effective clearinghouse makes the submission and management of claims simple, easy to learn, and monitor – a single location for claims management.
• Efficiency - From clearinghouse.org, we find that “the average error rate for paper claims is 28%. But using the right clearinghouse can reduce that to 2-3%.”
• Control – A clearinghouse delivers a provider-specific portal which serves as an all-in-one centralized location to monitor, manage, and extract necessary information.
• Speed – A clearinghouse facilitates quicker claims turnaround with higher claims success.
• Peace of mind – With a clearinghouse, billers have the confidence that they can track all claims easily throughout the entire claims-based revenue cycle.

It all makes cents.

Present on Admission, handling rejections, and shortening the revenue cycle topped this month’s key claims management blogs. Here are the key topics for this month:

To get paid or not, the answer could be a simple “Yes” or “No” – POA

Some SNF providers strongly assert that HAC-POA (Hospital Acquired Condition-Present on Admission) indicators do not apply to claims submitted to SNFs. Yet, recently an entire batch of claims submitted to a large insurance carrier was rejected, because the SNF provider’s billers had not included the POA indicator.

• What is a Present on Admission Indicator?
• Why POA could be important to SNFs
• How should billers use the POA?

No pain, no gain–not true. 4 ways to deal with claims rejections pain

One of the pervasive and overlooked pains in claims management involves claims rejections. Claims rejections require the billing staff to review the claims, address whatever is missing or in error and resubmit the claims in order to get paid. In some cases, payers reject specific claims over and over again. What’s even more painful is that billers, with the best of intentions, sometimes will put the rejected claims in a file folder which, if not dealt with immediately, can collect dust. Are you feeling the throb?

• Pay attention to rejections
• Discover the issue and if it is something you can control, address and fix it quickly.
• Check the contracts.
• You may have to stop accepting certain insurances/payers.

3 unique ways to shorten revenue cycles

LTPAC CFOs in the 21st century have to be concerned about many things. But in reality, much of what CFOs do revolves around getting paid on time in the amounts anticipated. Perhaps paying attention to the not-so-obvious factors influencing payment may be worth investigating.

Three ways to shorten the revenue cycle by “developing and leading the finance team to maximum productivity and responsiveness”:

• Improve A/R team job satisfaction
• Address claims processing costs
• Pay attention to Medicare Secondary Payer (MSP) claims