Hospitals are integral parts of our communities’ well-being providing large-scale employment and care to citizens. In today’s healthcare industry, many medical facilities are challenged to balance financial demands while continuing to provide quality care. In most cases, they are being asked to do more with less.
Unfortunately, today many providers reach a dire financial situation before they seek assistance from outside experts. Faced with this set of circumstances, management goes into a reactive mode to try and regain ground, which can be a losing battle. It’s vital to take a more proactive approach earlier in the game to improve performance and viability.
There are several operational warning signs that should put healthcare executives and financial managers on alert as each can negatively impact ability to perform effectively and efficiently. Some of these include:
- Inaccuracy of registration and insurance information
- Lack of proper pre-authorization
- Delays in receipt and inaccurate physician documentation
- Coding and billing staff workload…increasing backlog
- Errors in clearinghouse submissions
- Payment posting delays
- Lagging collection timelines
- Lack of payer contract requirement understanding
- Denial response times
These issues can be caused or magnified by process, technology, and staff inefficiencies. To preclude such situations, the goal should be ongoing assessment of performance through internal audits in all areas that impact the revenue process. This approach helps to stay in front of potential problems.
The key to improvement once a problem situation is identified is to start with an in-depth revenue cycle review of the facility. This exercise provides a fresh perspective and understanding of the current situation to hospital leadership staff. It also helps in defining a roadmap that directs how to implement changes and increase facility success.
With the Revenue Cycle Review complete, recommendations can be made on a solution or solutions to effectively manage a Business Office to improve processes, technology, and resource effectiveness. It’s critical to bring in the right resources at the right time to reduce expenses and ramp up cash collection capabilities with efficient processes.
As a business processing company, Signature Performance’s partnerships to date with healthcare facilities and systems have resulted in significant process optimizations, improved cash flows, and increased compliance for clients. In each engagement we have streamlined and automated processes to gain efficiencies in both manpower and cash flow, supported each facility through system optimization, and provided education and compliance in areas we support.
Following is an example of a client situation in which Signature worked in conjunction with the hospital to create sustainable and improved results:
Signature was brought in to assist with a hospital due to increasing A/R and staggering reimbursements. Our team quickly identified and remedied the root cause for several varied issues impacting A/R. As a result, overall A/R has been reduced to its lowest level ever. Denial rates dropped below 5% for all payers. Getting clean claims out the door was a major contributing factor to this positive turnaround. The client was close to 60% prior to Signature’s involvement, and now is at 95%+.
Signature is a valuable resource to providers, proactively improving financial processes in healthcare administration. Our work has created stability and growth to increase long-term success. Find out more about our approach to preempting risky situations and creating improved performance in and revenue cycle management.
Chris Vairo is the Chief Revenue Officer at Signature Performance Inc., in Omaha, NE. Signature Performance is an industry leader in reducing healthcare administration costs for private and public healthcare sectors. Our unmatched experience in serving both the payer and provider side of healthcare financial management allows us to implement innovative solutions for every administrative demand.