Quality v. Quantity: The Hidden Issue That Can Impact Your Revenue Cycle

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If you’re an ambulatory surgery center (ASC) trying to navigate changes as healthcare transitions to a value-based system, you know that strong revenue cycle management is more important than ever. But any number of issues can affect a facility’s cash flow. And while you can—and should—constantly measure the health of your cycle, (including key performance indicators like cash collections as percent of net revenue and days to bill), there are additional factors within these data points that can contribute to a positive—or negative—bottom line.

The medical revenue cycle is complex, so it’s not always obvious where problems affecting billing and collections come from. One of these “hidden” issues that tends to arise is the focus on the quantity over the quality of work accomplished by staff throughout the revenue cycle process. Much like providers, whose focus is shifting to quality over quantity of care delivered, revenue cycle staff must ensure that every activity they undertake has demonstrable value.

Consider the following ways a quantity v. quality problem may negatively affect your cash flow:

Denial & "Touch": In a well operating revenue cycle, approximately 80 percent of claims are paid easily, without any type of denial or request for additional information. But 20 percent of claims have an issue that requires some sort of follow-up by staff. Many facilities only pay attention to the number of accounts worked or “touched”. An employee might believe they did a superior job because they worked 95 percent of their problematic claims for the month. But those follow-ups may not have addressed any outstanding issues— nor moved the claim forward in any way toward getting paid.

This situation is known as a “touch”. A touch gives an employee credit for a follow-up because they essentially put a note on an account explaining that they reached out regarding the denial, even though they may still not know when you can expect to get paid. Without true follow-up work that results in direct contact with payers and steps toward resolution, it can quickly become 60-90 days before the real issue behind a denied or stalled claim is realized, resulting in sluggish cash flow and potentially lost revenue.

When the goal is to resolve the situation and receive payment, it is more important to track when contact has been achieved, claims issues have been identified, and the appeal process is in motion.

Poor Coding: Another aspect where facilities tend to focus more on quantity over quality is coding. If you're not managing and auditing the quality of your coding, you could impact cash collections in a negative way and not receive deserved reimbursements. Coding has become more complex with the transition to ICD-10, and if staff doesn’t pay close attention to the coding process, they can create errors that lead to unnecessary denials. Of course, you want to keep days to bill low, but it is better to take more time on the front end to ensure the documentation for a patient visit supports the coding submitted. A focus on quality coding is absolutely necessary to mitigate denials and even serious compliance issues that can cause a lot of trouble for your business.

How can you remedy these issues? When any of your data points — like your KPIs — are not up to par, you need to perform a meaningful audit of the work being done within your organization. Remember that revenue cycle is a service business requiring people and human interaction every step of the way. And if you don't have people that are fully trained for their position, fully aware of their expected results, and fully accountable for those results, these hidden issues can arise — and you may find that the hours of work being put in aren’t accomplishing the tasks at hand.

Explain to your team how the audits will work, how their performance will be judged and scored and how the numbers are used to reflect results. As soon as the audit is complete, document your findings and focus in on where there is opportunity for retraining. Do you need new policies and procedures, or a new explanation of outcome expectations? And does your staff have the tools they need, and know how to use them? Take steps to resolve the issues at hand, then perform an audit again in a certain period of time, holding people accountable for the results. You can also consider partnering with an ASC revenue cycle expert like SourceMed to get your processes on track.

Another thing to remember: the work is never finished. If you don't look at and evaluate your data consistently, hidden issues like prioritizing quantity over quality can become even larger. Be sure to maintain a constant cycle of audit, feedback, and retraining to achieve peak performance from your staff — and your revenue cycle.

 

 

Topics: Revenue Cycle, ASC Solutions

Quality v. Quantity: The Hidden Issue That Can Impact Your Revenue Cycle

shutterstock_308702423.jpg

If you’re an ambulatory surgery center (ASC) trying to navigate changes as healthcare transitions to a value-based system, you know that strong revenue cycle management is more important than ever. But any number of issues can affect a facility’s cash flow. And while you can—and should—constantly measure the health of your cycle, (including key performance indicators like cash collections as percent of net revenue and days to bill), there are additional factors within these data points that can contribute to a positive—or negative—bottom line.

The medical revenue cycle is complex, so it’s not always obvious where problems affecting billing and collections come from. One of these “hidden” issues that tends to arise is the focus on the quantity over the quality of work accomplished by staff throughout the revenue cycle process. Much like providers, whose focus is shifting to quality over quantity of care delivered, revenue cycle staff must ensure that every activity they undertake has demonstrable value.

Consider the following ways a quantity v. quality problem may negatively affect your cash flow:

Denial & "Touch": In a well operating revenue cycle, approximately 80 percent of claims are paid easily, without any type of denial or request for additional information. But 20 percent of claims have an issue that requires some sort of follow-up by staff. Many facilities only pay attention to the number of accounts worked or “touched”. An employee might believe they did a superior job because they worked 95 percent of their problematic claims for the month. But those follow-ups may not have addressed any outstanding issues— nor moved the claim forward in any way toward getting paid.

This situation is known as a “touch”. A touch gives an employee credit for a follow-up because they essentially put a note on an account explaining that they reached out regarding the denial, even though they may still not know when you can expect to get paid. Without true follow-up work that results in direct contact with payers and steps toward resolution, it can quickly become 60-90 days before the real issue behind a denied or stalled claim is realized, resulting in sluggish cash flow and potentially lost revenue.

When the goal is to resolve the situation and receive payment, it is more important to track when contact has been achieved, claims issues have been identified, and the appeal process is in motion.

Poor Coding: Another aspect where facilities tend to focus more on quantity over quality is coding. If you're not managing and auditing the quality of your coding, you could impact cash collections in a negative way and not receive deserved reimbursements. Coding has become more complex with the transition to ICD-10, and if staff doesn’t pay close attention to the coding process, they can create errors that lead to unnecessary denials. Of course, you want to keep days to bill low, but it is better to take more time on the front end to ensure the documentation for a patient visit supports the coding submitted. A focus on quality coding is absolutely necessary to mitigate denials and even serious compliance issues that can cause a lot of trouble for your business.

How can you remedy these issues? When any of your data points — like your KPIs — are not up to par, you need to perform a meaningful audit of the work being done within your organization. Remember that revenue cycle is a service business requiring people and human interaction every step of the way. And if you don't have people that are fully trained for their position, fully aware of their expected results, and fully accountable for those results, these hidden issues can arise — and you may find that the hours of work being put in aren’t accomplishing the tasks at hand.

Explain to your team how the audits will work, how their performance will be judged and scored and how the numbers are used to reflect results. As soon as the audit is complete, document your findings and focus in on where there is opportunity for retraining. Do you need new policies and procedures, or a new explanation of outcome expectations? And does your staff have the tools they need, and know how to use them? Take steps to resolve the issues at hand, then perform an audit again in a certain period of time, holding people accountable for the results. You can also consider partnering with an ASC revenue cycle expert like SourceMed to get your processes on track.

Another thing to remember: the work is never finished. If you don't look at and evaluate your data consistently, hidden issues like prioritizing quantity over quality can become even larger. Be sure to maintain a constant cycle of audit, feedback, and retraining to achieve peak performance from your staff — and your revenue cycle.

 

 

Topics: Revenue Cycle, ASC Solutions

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