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Claims Optimization

Enhancement of the revenue cycle relies upon many factors, several of which have been outlined in previous blogs. These factors include paying attention to optimizing the efficiency of the cycle itself, optimizing the quality of the claims that are sent out to payors, maintaining technologies that are efficient in producing meaningful data that translate your work into documentable services that can then be relayed clearly and accurately to payors, and enhancement of these technologies with additional help that improve quality of documentation and claims. All of these aspects help to ensure a successful and productive revenue cycle.

Here is a review of some key pointers for optimizing claims (and thus the revenue cycle) from previous blogs.

Use of scribes

The accuracy of claims begins with accurate documentation of a healthcare provider’s services for a particular care episode. Without clear documentation and accurate capture of medical events, this not only makes it difficult to coordinate care, but to come up with convincing claims that are thorough enough to achieve approval and ultimate payment from the payor. The use of medical scribes can enhance the quality of future claims by establishing an accurate record of medical services from which the billing personnel can work with to designate the proper codes necessary for a successful claim.

Real-time billing

To reduce medical errors and save time in back-log work that would result from seeing patients and documenting after the visit is over, real-time billing is becoming the new form of work-flow that enhances efficiency by on-the-spot documentation, immediate communication of patient services, and correct coding for the perfect, undeniable claim. In such a system in which the medical scribe communications directly with billing personnel, this takes care of two tasks at once (medical and financial) all while the data from patient examinations is still being accumulated. This reduces errors that can result when trying to recall information after a patient visit.

EHR enhancement

Optimization of your EHR as well as optimization of how you make use of your EHR is also essential for taking the accurate documentation from the medical scribe and making it useful to your work-flow (and revenue cycle). Structuring your EHR to fit your workflow will not only make the patient service process faster, but also the billing process. The interoperability of your particular EHR database system with other databases from organizations or healthcare providers with whom you work with should also be taken into consideration, particular for coordinated care episodes. This helps in getting everyone involved in the care process on the same plane with what has actually happened, what is the current condition of the patient, and what needs to be done next. This clarity within a health organization network is also a helpful check when it comes to claims. If various work-flows are all in alignment, the chances for a claim that is reasonable and subject to approval and payment is highly likely.