The revenue cycle is complicated. With uncompensated care on the rise, healthcare providers need to make smarter decisions to stay in the black.
Uncompensated care was the central theme during our roundtable discussion at Becker’s Hospital Review Health IT and Revenue Cycle Conference, where I had the pleasure of moderating dialogue around revenue recovery topics. Our panelists — Leslie Richard, National Director of Revenue Cycle Management at Catholic Health Initiatives and Mike Miller, Director of Reimbursement at Sanford Health — offered insights on how to protect earned revenue by using solution-focused technology to recoup reimbursements.
Here are a few key takeaways on the topics of Medicare reimbursement, insurance discovery and patient access.
Medicare reimbursement optimization
- Be vigilant with your documentation of Medicare beneficiary bad debt (MCBD).
Identifying and tracking nonpayment from Medicare patients can be burdensome due to fragmented processes and staffing constraints that often leave earned revenue on the table. Having an external solution in place to automate complex Medicare reimbursement opportunities can enhance your recoupment efforts.
- Take advantage of any and all reimbursement opportunities.
Revenue from Disproportionate Share (DSH) payments, Transfer DRG, MCBD and other Medicare reimbursement can be lost as rules and regulations change. That’s why it’s important to take advantage of these reimbursements when you can. While finding these reimbursements is a tough — and often manual process — it can make a big difference on overall yield, so it’s important to capture every last dollar.
- Know that charity care can drive the percentage of recovery you get.
Charity care drives DSH payments. You want to be sure your organization is identifying it properly. Your S10 reporting and charity determinations hinge on identifying the accounts and proper documentation — but you have to get it right to ensure your share is maximized. Due to the fact that DSH and 340B can account for significant reimbursements, once you become eligible you don’t want to lose this status.
- Focus on the patient financial experience to curb leakage.
The patient experience becomes more positive when you can personalize their payment plans. Patients don’t want a surprise bill. Meet them where they are and help guide your collection strategies accordingly. Engaging patients early creates a transparent revenue cycle that will drive patient satisfaction and loyalty — which also accelerates cash yield.
- Put solutions in place throughout the revenue cycle to maximize yield.
Protect your revenue by finding as much missed coverage as possible. Ensure you have the best insurance discovery vendor in place to help you find coverage that would have otherwise gone to bad debt.
- Dissect your data to find missed opportunities.
Improve your insurance discovery processes by problem solving and challenging your external partners to find more coverage. If you feel like you’re missing opportunities, you likely are. If a vendor isn’t willing to work harder, replace them.