Category: For Hospitals & Physician Groups

In the Healthcare industry, mergers and acquisitions (M&A) are everywhere. Even among the revenue cycle vendors who serve the industry, consolidation is the new constant. But what does this mean for you and your healthcare organization?

When a merger occurs, the newly formed vendor conglomerate may choose to convert acquired clients to a single system rather than carry the cost of supporting multiple product platforms. Through no choice of your own, your organization may be faced with the cost of an unplanned RCM system conversion.

During M&A integration, customers from both companies will face changes. How these changes impact customer choices can immediately impact customer experience. When you chose your RCM vendor, you sought the software, service, and support that best met your healthcare organization’s needs. How will the changes you are being forced to make impact your revenue cycle and reimbursement needs?

If you are being forced to make a system change, do not feel trapped by your current RCM vendor. Take back control—consider all your options. Revisit your decision model. To get started, review the 8-Item Checklist for Picking the Right RCM Partner and the Top 5 Ways to Optimize RCM Management. Focus on those capabilities you need to successfully drive your organization’s mission: data analytics, operating efficiency, and technology integration.

Data Analytics – Put Your Data to Work

Look for an RCM solution that provides visibility into your revenue cycle so you can gain insight, take action, and deliver results. Select a solution where you can monitor KPIs and benchmarks to uncover actionable patterns in your billing and reimbursement data. Make sure it has an analytics front-end that presents easily-consumable dashboards and reports—visual charts and graphs—so you can quickly identify trends and quantify impact to make data-driven decisions.

Operating Efficiency – Take Control of Your Cash Flow

You need your revenue cycle to be a highly-functioning, results-oriented operation. Find an RCM solution that will automate your claims, fast-track your receivables, and coordinate your denials and appeals management efforts. All with configurable workflows that you control and customize.

Technology Integration – Connect Everything

The right RCM partner will have technology that interfaces seamlessly with your EHR. To promote seamless integration, your RCM solution should be able to support APIs, web services, and both standard and non-standard interface types—making data connections secure, controlling access with minimum necessary use while not impeding productivity. Find a vendor who combines smart technology with superior service.

Mergers and acquisitions favor the joining partners. Customers and clients can be in for a rocky transition, especially if vendors have not fully vetted their M&A integration plan. If you are facing an unplanned RCM system conversion due to vendor consolidation, why not choose the vendor that fits you best? Make the choice that serves your RCM needs today and in the future. That may, or may not be, your newly formed vendor conglomerate.

Optimize Unplanned Transitions – Choose Agile Stability

While considering your RCM options, you may want to learn more about The Quadax Advantage.Demonstrating agile stability in the midst of healthcare’s ever-changing ecosystem, Quadax delivers innovative RCM software, service, and support. An enduring industry expert, with more than 40 years of healthcare experience, we provide clients a continuity of excellence. Creating connections, providing intelligence, and equipping providers, Quadax can help optimize your revenue cycle.

Thrills and chills may be fun at Halloween, but not when staff is trying to process claims. Things that go bump in the night can be causing payment delays! Exorcise the ghosts in your revenue cycle—review these ghost busting tips and get the most from your RCM claim processing and clearinghouse solution.

Feeling Vexed by Your Automation’s Limitation?

Intelligent automation throughout your claims process can help accelerate your revenue cycle. Are you experiencing ghastly gaps in your automation?  What can you do about it?

Frequent interruptions caused by your upload routines can make staff fear the start of a new day. If daily interfaces are failing, you may want to implement custom interface logic and monitoring tools. This can improve claim data integrity while safeguarding staff productivity.

When front-end payer rejections prevent your claims from reaching payer adjudication, it may be time to consider a new clearinghouse. If your claims first pass rate is less than 99.6%, then your RCM is being impeded by an under-performing editing engine. Your claims processing engine needs access to the must current industry rules for cleaner claims and faster reimbursement.

You cannot afford to still be processing paper when electronic options are available. If you are still sending hardcopy claims, engage your clearinghouse’s electronic payer connections to send more claims electronically. Electronic processing can expedite payment by cutting claim processing lead time by more than half.

Feeling Poorly About Productivity?

With the right RCM tools and resources, staff can enhance productivity and optimize claim processing. Are frightful system inefficiencies terrorizing your staff? Identify where and when and ways to solve them.

Repetitive manual processing delays all good men and women from achieving their best. Do not allow your staff to be held hostage by the RCM vendor who only allows for custom programming. Enable your staff with high-performance tools and resources. Your RCM solution should allow your staff access to self-help options for engaging your system’s automation. We recommend easy-to-use wizards where staff operators can create auto-correct rules and custom claim edits specific to your business needs.

Paper worklists limit management’s ability to optimize your billing operation and balance workloads. Make sure priority claims are worked first. Organize your labor force using configurable electronic worklists, integrated reports and dashboards, to prioritize work for maximum effectiveness.

Clumsy communications among claim processing teams can put your organization at risk for security issues and inappropriate disclosures. Stop staff from using emails and shared spreadsheets. Expect your software to provide for cross-functional, interdepartmental workflow and communication, especially when a claim requires special handling. It should also provide for automated comment records to keep staff and systems in-step and in-sync.

Feeling Devastated Over Missed Deadlines?

One of the most deadly claim processing errors is missing a payer filing date. Is your RCM system allowing you to miss filing deadlines?

Do not let your revenue be defeated by the walking dead; make sure your claims never miss a deadline. At-a-glance dashboards and warning flags can help you monitor age of claims and days in A/R so that filing dates are managed and met.

At Quadax, we aren’t afraid of ghosts!

If there is something strange in your RCM neighborhood, something’s weird and it doesn’t look good, who can you call? Quadax Xpeditor™ can free your RCM of haunted processing.

Make sure your claims reach payer adjudication. When selecting a clearinghouse, compare first pass rate—percentage of claims accepted for adjudication on initial submission. A difference of one percent can represent thousands of claims. Learn more about Quadax’s industry-leading 99.6% first pass rate.

Automation is a logic process existing in a living ecosystem. Smart automation, built on the knowledge and information available at the time of design, anticipates the future and accommodates the need for change. Healthcare organizations facing ever-changing industry regulation and payer requirements can benefit from revenue cycle oversight and change management control to keep RCM automation operating at peak performance.

The Value of Automation

When tasks are repetitive and outcomes are reliably reproduced, automation brings increased efficiency and accuracy.  By quickly and reliably processing large volumes of electronic transactions, automated workflows can streamline your claims management and reimbursement activities. However, within healthcare’s reimbursement ecoystem change is inevitable, and RCM automation left uncalibrated for changes in payer requirements and government regulation can result in increased manual review and rework.

How Does Your Automation Account for Change?

All automation will face change. What makes automation intelligent, as well as efficient and accurate, is how it recognizes and processes change. Does your revenue cycle system alert billing specialists that it has found a new data element? Does it capture the new data and metadata? Is normal claim and remittance processing able to resume? Do billing specialists have a convenient interface for either correcting the data error or adding new logic to automated transaction processing?

Human intervention is critical

While it may seem appealing to program humans out of the man-machine systems we automate, the human operator provides judgment, logic, and opinion. As a component in the control system, humans are variable, interactive and adaptable—able to creatively respond to changes or unforeseen conditions. A person can identify and take creative action. With integrated change management tools, people can calibrate automation for changes as they occur. Balancing efficient and accurate RCM automation with human oversight and manual intervention is key. Smart design will determine what level of integration between automation and human intervention is best for optimal revenue cycle performance.

The BEST solution

An optimized system will maximize performance and minimize human error, operating somewhere between full automation and complete manual control. Where on this continuum a system should operate, of course, depends on the application. User operators should have a monitoring role in the automated system with override capabilities as needed, receive adequate feedback on system status with enough time to respond, and can trust the accuracy and reliability of the system.

Oftentimes systems are designed with economic benefit being the driving force for determining which aspects of the system will be automated and how. Then oversight control is integrated into the system in an “after the fact” manner leaving the user operator to manage the results of the automation. User operators can find themselves held hostage by automation that has become obsolete. Automation without the support of change management tools, can have a short shelf life. Be sure you have the ways and means to keep your automation operating at peak performance.

Stay in Control of Your RCM

At Quadax we understand your organization is poised for growth and change and that the revenue cycle automation we help you implement today will need to solve for your future state as well. With deliberate planning, our solutions offer user-friendly options for manual intervention, allowing our automated solutions and workflows to remain flexible and configurable to meet our clients’ changing needs. With various wizards and user interfaces, we integrate your staff and system. With responsible monitoring, our systems notify staff when new data events occur and support manual intervention for exception processing and handling. At Quadax we make sure your RCM automation stays current with your changing demands, ready to solve your revenue cycle complexities today and in the future.

Automation can rev your RCM and optimize your ride. Keep your automation operating at peak performance. Quadax oversight and change management controls allow you to tune-up your RCM without having to take it into the shop.

Know what you are owed, collect what you are due, and negotiate what you are worth. With so much of healthcare reimbursement administered by contracts, oftentimes complex and requiring lengthy payment terms, it is not surprising that hospitals and health systems experience leakage in their revenue cycle. Revenue assurance through contract management can plug the leaks, preventing unplanned and unexpected cash outflow. Consider implementing net patient service revenue assurance measures. Integrating contract management into your revenue cycle can help you calculate your expected cash correctly and protect its inflow.

The average healthcare organization experiences a 5% loss in annual net patient service revenue due to preventable revenue leakage.* It is also estimated that 7-11% of claims are underpaid.** The American Medical Association estimated that 7.1 percent of paid claims contain an error. That means for every 100,000 claims your organization processes, 7,143 will be paid incorrectly.

At the heart of the issue is an organization’s ability to apply contract management control to its claims management and reimbursement cycles. Managing and maintaining dozens of payer contracts, each administrating different payment terms and conditions based on numerous factors, can make calculating expected net patient service revenue complex. But without that calculation an organization cannot identify the true worth of a claim or if the reimbursement received was in variance.

Imagine the power of being able to project your cash flow with confidence; to monitor and act on payment variances. What if you could recoup identified underpayments and shortfalls en masse with “one-click” ease? How would it improve your payer negotiations if you could analyze actual and expected cash flow by procedure, by payer, by contract? With the right contract management and modeling solution, you could gain the strategic control to prioritize and maximize your revenue results.

But what about the cost of implementation? No matter how good a contract management solution claims to be, it is only most efficient when it is seamlessly integrated with the industry’s best clearinghouse as its foundation. Learn more about the Quadax Contract Management Solution when you download the FREE e-book. Let us help you optimize your revenue cycle!

Download Strategic Cash Flow Control Using Contract Management for Hospitals and Health Systems.

(*) source: 2016 Healthcare IT Forum, Advisory Board

(**) Medical Group Management Association (MGMA) Research

In Patient Financial Services (PFS) offices across the country, words like swamped, frustrated, and stressed can be heard as frequently as patient, billing, and coffee. The work is never-ending, with the rules ever-changing. In this world of chaos, when so many of your daily challenges are outside of your control, a claims management solution can help you avoid roadblocks, bringing order and peace of mind. How does a good claims management system deliver the control you seek?

Organize the work.

Your first line of defense against the chaos: organization. The principles of masterful organization are identify, classify, categorize, prioritize, and mobilize. To effectively deploy these strategies in your claims management system, start with workflow rules, statuses, queues, and views.

• Workflow rules
  Workflow rules put work where it needs to be, not where it doesn’t. Organized workflow rules identify and classify, routing the right work to the right people so those responsible can complete it. Only the persons responsible for completing it see it; others are not distracted by it, and the work is done once. Multiple touches impede efficiency, increase cost, and can cause confusion.

• Workflow statuses
  Workflow rules also drive the status of claims, labeling them appropriately according to the intervention required so that work is grouped efficiently and will not fall through the cracks. Review the statuses in your claims management system periodically, as well as the conventions for their assignment, to ensure that the statuses correspond to logical classification – enough to provide clarity and direction, not so many that they are perplexing.

• Work queues or views
  When the queues or views within your claims management system are organized, not only will the right work get to the right people, but it will be prioritized according to best practice for your organization. The easier it is to see what needs to be done, the easier it is to get it done.

Automate, automate, automate!

Automation is one of the best ways to ensure the cash flow is steady and dollars are not diverted from your mission. According to the 2016 CAQH Index, manual claims management processes cost providers $4 more than electronic transactions. So not only is manual work more costly, but these tedious and time-consuming tasks take your staff away from other work.

Examine the manual interventions currently required of your staff, particularly those that are highly repetitive. Configure rules within your claims management system to automatically process these tasks. Using automation you can optimize workflows and increase staff productivity.

Share knowledge and best practices.

Share knowledge and best practices with your staff. Provide an easily accessible resource that contains error details and other EDI-related information, explains payer requirements, and identifies best practices. If the answers to most questions and concerns can be found at your employees’ fingertips, costly mistakes can be avoided. Not only will your staff be more knowledgeable, but you and your team will gain control over your claim processing protocols.

Avoid claim processing roadblocks.

Are your claims traveling the best path for payment? Review your claims processing roadmap. Where in your claims’ journey is your staff experiencing roadblocks, pile ups, and bottlenecks? To help in your review, download Quadax’s claim processing infographic. A good claims management system can deliver the control you seek.

July was National Picnic Month; did you celebrate? If you did, perhaps it occurred to you, as it has to us, that there are a number of ways running a Patient Financial Services (PFS) office parallels great picnic planning. The picnic best practices listed below clearly translate into revenue cycle success, as well!

Plan Well

Planning carefully for your picnic by thinking through each facet of the event helps to avoid mishaps, making the event more pleasant for you and for your guests. Then, turning one-time planning into a reusable picnic checklist will mean even easier preparation for your next al fresco adventure!

Thorough planning is critical, too, for operational efficiency in your business office. Documenting your plans and applying continuous improvement to them over time ensures ongoing success in areas like:

• The efficient division of labor by balancing workload appropriately
• A file transfer schedule based on clearinghouse and payer acceptance cutoffs
• Programmatic automation for routine tasks

Prep Ahead of Time

Great picnicking depends on doing as much advance preparation as possible. Food prep is a given, but also napkins rolled up individually with cutlery for easy distribution, and having insect repellent, sunscreen, wet wipes and adhesive bandages on hand.

In the PFS office, the work you do up front, before your claims drop, makes a huge difference in your ability to move claims to adjudication in the most cost-effective way possible. Don’t miss these critical advance prep steps:

• Make sure that eligibility verification and medical necessity checks are being performed pre-service to avoid issues downstream
• Keep your payer table up to date in your EHR and in your clearinghouse software
• Configure auto-correct rules in your clearinghouse software to overcome known shortcomings in claim preparation by your EHR

Keep it Easy to Eat

Balancing a plate of messy food (or failing to balance it!) can really distract from the pleasant picnic atmosphere. Serving food that’s contained – hand-held, even – is a great alternative. Calzones and empanadas are easy to transport and eat, and completely prepared in advance.

Establishing containment in your business office is a good way to stay organized and prevent the distraction—and wasted resource—of work duplication or inefficient procedures. Keep your processes in hand by taking advantage of:

• Logical workflow, with well-defined work queues to keep specialists working their specialties with nothing falling through the cracks
• Electronic routing of worklists, with system notes added to facilitate collaboration when claims must be routed back to Medical Records or Utilization Review, for example
• Prioritized intervention based on expected reimbursement

Prevent Spoilage

Avoiding problematic salads with mayo-based dressings is a great preventative measure; so is making use of sturdy sliced vegetables rather than tender butter or leaf lettuces that will fade in the heat. Grain-based dishes dressed with vinaigrette like this couscous salador this gluten-free quinoa salad are tasty options less prone to spoilage.

The “spoilage” date for claims—per timely filing standards—varies by payer, so be sure that you and your staff know what the rules are, and where your claims are in each timeline. Helpful ways to keep track:

• Configure your at-a-glance dashboard to include a snapshot of the age of your claims in active inventory
• Employ aging as a factor in your claim intervention prioritization by sorting workflow queues on the pertinent date (e.g. date of service)

Avoid Throwaways

Relying on disposable goods like paper plates for outdoor eating means unnecessarily disposing of cash as well as having more trash to deal with. Keeping a set of break-resistant plates, cutlery, and glasses in your picnic stash so they’re always ready when you are eliminates both problems.

Paper means extra expense in PFS, as well. Reduce your reliance on paper and realize time and cost savings with these tips:

• Confirm that every payer able to receive claims electronically is configured as an electronic payer in your clearinghouse software payer table to avoid unnecessary paper submissions
• Make use of electronic claim attachments to cut down further on hardcopy claims
• Capitalize on your clearinghouse software’s ability to bring payer-rejected and denied claims back into your workflow electronically to eliminate working from paper reports or worklists
• Employ a system for converting paper remittances to electronic 835s

Think “Double-duty”

Planning for double-duty service from the items you take cuts down on the load you need to haul. Cloth napkins and tea towels (for place mats) make for a festive picnic and are useful for padding while packing. A resealable bag filled with ice cubes serves as a cold pack as you travel with food, then the cubes may be used in the beverages you serve.

Thinking double-duty in your business office is a necessity to reduce your cost to collect. Make the most of your investment by taking advantage of everything your systems have to offer, for example:

• Have comment records generated from your clearinghouse software to post claim modification tracking and status tracking back to your host system
• Configure a remits-for-posting folder with scripting to take ERA from your clearinghouse system for automated posting to your host system
• Allow your clearinghouse software to generate secondary and tertiary claims while processing remittance files, in order to automatically apply all primary payer remittance data required for coordination of benefits (COB)

Regardless of the similarities, of course, it probably seems a stretch to consider PFS a picnic. The challenges are real. Fortunately, so are the improvements that can be realized with these and other best practices for operational efficiency. Find out how Quadax can help—contact us today to request a consultation!