On the heels of the pandemic and the “Great Resignation,” health systems and physician organizations across the country are struggling to maintain optimal staffing. While most of the spotlight has been on clinical staffing shortages, the challenge is just as significant for non-clinical staff. A recent article by Becker’s Hospital Review confirms that “Front-end revenue cycle staff, back-office specialists, coders, accounts receivable, and denial management experts are all in short supply.”
For organizations that were already struggling with paper-thin margins before the pandemic, having backlogs in the revenue stream due to a shortage of workers is the last thing they need. Cogs in the insurance billing process lead to delayed reimbursement, lagging days in A/R, and poor cashflow—not an optimal scenario for successful post-pandemic financial recovery.
According to the January 2022 National Hospital Flash Report, between December 2019 and December 2021 the median change in hospital operating margins (without CARES) dropped 14.7% while labor expenses per adjusted discharge increased 26.8%.
Just as times of crises highlight systemic weaknesses, they also highlight opportunities for improvement. The revenue cycle is one such opportunity. Following are four steps you can take to shore up your revenue cycle processes, mitigate the impact of staffing shortages, and become better positioned for the future.
Automate patient access
It’s a fact that a large portion of denied claims are caused by issues in the patient access process; close to 24% are caused by registration or eligibility issues and 12.4% are caused by issues with authorization and precertification requirements. Fortunately, patient access technology can eliminate many of the manual processes that lead to denials.
Automated patient access technology reduces time-consuming processes like calling payers to gather coverage information. By removing manual processes, it also reduces the likelihood of errors and missing patient information when it comes time to file the claim or bill the patient—both of which can lead to rejections or denials.
Focus on clean claims
Having overworked coders or high staff turnover in this area can reflect poorly on your clean claims rate. Overworked staff may not have time to be as careful as they could be, especially if they have to take time to train new staff. And using inexperienced coders can increase the likelihood of errors. The result is increased rejections and denials, even more work for your team on the back end and, ultimately, lost revenue. The importance of ensuring clean claims cannot be overemphasized.
One of the best ways to shore up your claims submission processes is to ensure that you are optimizing your claim scrubbing technology. An optimized system will generate cleaner claims and fewer denials, thereby resulting in less work, faster payment, and increased cash flow. Optimizing your claim scrubbing technology can help mitigate the many issues that come from staffing shortages and turnover.
Rethink denial management
Denied claims mean denied revenue. Yet many organizations simply don’t have the resources to review and rework every denied claim. Many choose to work only the highest dollar claims. That approach, however, leads to much needed revenue being left on the table. Smaller amounts are often low-hanging fruit that may be easily captured.
Having the right technology in place allows your teams to work smarter. Rather than just working denials based on balance or age, the analytics provided through the right technology allows staff to score denials based on balance, age, filing limit, denial type, and more. Having this information enables more effective root cause analysis, which can help them further segment denials based on the probability of collection and historic appeal overturn rate.
Having this level of insight helps staff be more successful without having to work harder or longer.
Make it easier for patients to pay
With industry changes have come increased financial pressures on consumers as well. The last thing you want is for your patients to delay or skip care. But you also can’t afford to spend months trying to collect patient balances or to write them off completely.
One of the best ways to help both patients and your organization is to make it easier for patients to pay. First, you need to provide the patient with an estimation of their portion of the financial responsibility up front. This allows them to make more informed decisions about how to pay for their care.
Second, you need to make it more convenient to pay. Whether through an app, online, or over a mobile device, digital payments are gaining in popularity among all age groups. For patients who prefer other options, you should provide several choices like through traditional customer service representatives or payment by mail, as well as automated phone payments.
Finally, consider offering flexible payment plans. The best options are those that consumers are already used to, like department store cards. Patients should be able to roll up all of their medical bills together and to add bills from other family members. Budgeting a single monthly payment for all medical bills is much easier than trying to keep track and pay multiple bills for multiple family members for multiple services from your organization.
Offering a more patient-friendly payment experience can enhance patient satisfaction while helping health systems and physician practices get paid in full.
The silver lining
Staffing shortages aren’t going to subside anytime soon. In fact, even if the level of shortages decreases, staffing will likely land in a different place than before the pandemic and the “Great Resignation.” With challenges and change comes opportunity. Organizations have the ability now to establish outsourcing partnerships, automate their revenue cycle processes, and proactively prepare for what the future might bring.