Best Practices for Improved Financials Post-COVID Part 1: Systems Optimization

The COVID pandemic became a public health crisis that presented challenges with growing repercussions. Practices had the task of pivoting their business and system operations to restore and strengthen revenues, adapt to the changing environment post-pandemic, and accelerate their growth.

In a webinar, medical billing experts from Coronis Health join for a panel discussion about best practices for improved financials post-COVID. Panelists also provide case studies on how practices have created smarter operations by leveraging technology, understanding coding and analytics, and reducing unnecessary fees. In this 3-part series, we share the highlights of that webinar and case studies to demonstrate the value of teaming up with experts in revenue cycle management.

The Critical Importance of System Optimization

The healthcare revenue cycle is very complex. There are many moving parts and different facets involved – all of which directly or indirectly impact your practice’s cash flow and revenue. 

One of the goals of Coronis is building a partnership that provides an analysis and review of existing operations and systems, with the goal of improving them and making them more efficient.

Optimizing Your Systems Case Studies

When you are reviewing your systems, you want to understand how you can optimize your systems best. But what does optimizing your system really mean? And how do you know you are actually optimizing your system? 

The first case study features a large pain group who loved their system’s EHR but was less than satisfied with the practice management system. 

We did a full task analysis of the onboarding process, identifying that the providers were very happy with the EHR, but on the back end, the administrators felt like they had no visibility on what was going on in the billing side. The staff didn’t understand where the charges were going or who was working on what. 

Despite the obvious issues, changing systems can be risky when it comes to cash flow and claims submission. How can we help these providers keep the EHR they love while achieving better visibility on the administrative side?

We took a look at their systems and moved them from their current practice management system to a new PM system. We did a system integration that pulled charges from their current EHR and sent them to their new practice management system. This enabled transparency while improving cash flow.

Results:

• Identified improvement on coding for ultrasounds due to client owning the ultrasounds (nice add-on)
• Increased overall monthly receipts by 10% because of improved coding and implemented audit for charge submission
• Provided access to Coronis Health BI tool to analyze denials to drive change
• Implemented click-to-pay patient statements to increase payment for patient receivables

Our second case study features a rural urgent care group that had an in-house biller for 20 years and was worried about outsourcing to a company that is not their own. For a group that belongs to a small, tight-knit community, they were also scared that these new individuals may not perform as well as those that have worked with them for 20 years. In addition, they had felt that since their system wasn’t broken, it did not need any fixing.

We wanted to understand their systems and their culture, because for us to build a partnership, we had to know what drove their business and what their patients’ expectations were. The practice was hit hard with COVID and almost had to close their doors because they weren’t able to keep the staffing on the front end to do patient registration. 

Within two months of working with them, we did a full task analysis on all their manual processes and created automation and efficiency to improve their revenue cycle. We utilized their specific software to help them with their manual tasks, and we implemented a verification tool that was already in the software to replace the manual task of verifying services.

Results:

• Helped the client keep their doors open to treat patients during the pandemic while taking care of the back office billing work
• Provided the client with resources to replace their retiring billing manager of 20+ years without causing a break/pause in the billing work
• Maintained the cash flow for the client during the initial transition period 
• Activated the verification tool that saved the the time required to go into different payer websites

Are you losing revenue due to inefficient processes? Let us help you optimize your systems and maximize your revenue cycle. Contact us today to learn more.

from
https://www.coronishealth.com/blog/best-practices-for-improved-financials-post-covid-part-1-systems-optimization/

Choosing the Right Outsourcing Service: 5 Questions to Ask

When you decide to outsource your medical billing, you need to do your research to ensure that you connect with the right company for your facility’s needs, such as claim processing, offered services, staff training, AR management, and analytic reports. When you find the right billing company, all of these needs – and more – will be fulfilled. 

1. How Quickly Will They be Able to Begin Processing Claims?

Prompt filing is critical to ensure your facility receives its reimbursement in a timely manner. Billing companies usually start processing claims within 30 to 60 days after signing a business agreement, but each company varies with its timelines. Check with multiple companies and find out if they are well versed with your facility’s billing software, or if they are familiar with other practice management software if you happen to be transitioning from one to another. Either way, you need to find a company that can work with your existing tools, or can transition with your facility as you make changes. This will ensure that they can start processing claims sooner than later.

2. What Services Do They Provide?

Revenue cycle management should be handled by experts who are familiar with all aspects of medical billing and coding. You will want to sign with a billing company that is familiar with all components of revenue cycle management, and identify your expectations about which tasks you want to oversee in your facility, and which services you want the billing company to provide. 

Some billing companies may not offer coding services, while others offer coding and charge entry, but do not handle patient accounts. Because each billing company offers something different, you need to find the company that offers exactly what you need, and can be flexible by offering à la carte services if you choose to handle some billing tasks in-house.

3. What Training Does Their Staff Receive?

During your search, ask each billing company if the billers and coders are certified by the American Academy of Professional Coders (AAPC), which offers training and certification for professional coders (both inpatient and outpatient), billers, auditers, and more. The training AAPC offers is industry-driven and current, and falls in line with how billers and coders should be managing their role within a billing company or healthcare facility. Training that is central to AAPC demonstrates that a billing company understands the importance of compliance, regulations, professionalism, and above all else – accuracy, which ensures that their clients are receiving timely payments. Ask about continuing education for a billing company’s team – for instance, how often their staff are trained, recertified, and provided with up-to-date industry information. 

4. Who Will Handle the Current Accounts Receivable (A/R)?

Choosing a billing company is an important decision, especially if you have old claims that date more than 180 days. When you sign an agreement with your selected billing company, set your expectations about who will handle old claims – your facility, or the new billing company. The best option may be a fresh start with your new billing company that begins with newer claims of 90 or less days. Your billing company consultant will guide you in making this decision, and how older claims can be managed. During the transition, you may be operating with two medical billing processes simultaneously as older claims either roll off, or are closed out through successful collection.

5. Will Monthly Financial Reports be Provided?

Medical billing companies have high-quality software to facilitate accuracy in reporting and provide a big picture of the revenue health of a healthcare facility. A billing company worth its weight will provide your facility with access to not only monthly reports, but access to dashboards that can create a central hub for analysis and interpretation. Look for a billing company that offers dashboards, summaries, trending reports, and also advice on how to use the reports to make changes or focus on process improvements for the revenue health of the facility. Worthy medical billing companies understand the importance of metrics and performance, and will work with you to set standards that are easily monitored. 

When you make your decision to sign with a billing company – you will find that the best company will answer these questions quickly, accurately, and give you the confidence you need to transition to outsourced medical billing. The revenue health of your facility depends on the quality of your billing company – so do your research, and choose a company that is not just a business partner, but a team member who truly accepts your facility’s mission and vision to offer the best services to its patients. 

Coronis Health allows you to remain independent and focus on caring for your patients, while we handle your medical billing and revenue cycle management. Are you ready to learn more? Contact us to request your free financial checkup.

from
https://www.coronishealth.com/blog/choosing-the-right-outsourcing-service-5-questions-to-ask/

Struggling with Staffing Shortages? We Can Help

Staffing shortages affect so many aspects of healthcare, from the delivery of patient care to the ability of an organization to retain quality talent. The pandemic is certainly a factor in recent staffing shortages, but shortages have been brewing for decades. Rural hospitals and facilities face staffing challenges now more than ever, but there are solutions that reach beyond traditional hiring. 

The Staffing Crisis 

The staffing crisis seems to be at an all-time high since COVID-19 hit the states in early 2020. Recently, data shows that 25% of hospitals in 13 states are facing critical staffing shortages of not only nurses, but doctors and other medical professionals. The shortages cause hospitals and ambulatory surgery centers (ASCs) to turn away patients who need care. The outlook is bleak as the Omicron variant of COVID-19 is increasing the statistics of cases, and is causing many emergency departments to close due to a combination of staffing shortages and over capacity. ASCs are also postponing elective surgeries due to lack of space and staffing. 

The following states are seeing record, and critical, staffing shortages, with some reaching as high as 40%:

South Carolina and North Dakota – 33%
West Virginia – 39%
Rhode Island – 40%
These are all more than twice the national average of 16.5%
Arizona, Wyoming, Kentucky, Wisconsin, California, Alabama, and Oklahoma – all reporting more than 25% shortages

These staggering staffing shortages are more than just critical – they are the worst in four decades, and create a number of hardships:

• Patients traveling hundreds of miles for specialty or advanced care due to shortages
• Hospitals operating under crisis standards, resulting in support from FEMA (Federal Emergency Management Agency) employees, volunteers, or military, or DMAT (Disaster Medical Assistance Teams)

Ultimately, staffing shortages affect patient care, employee morale and retention, and force organizations to resort to extreme recruiting efforts to fill critical positions. Even the Centers for Disease Control and Prevention (CDC) is recommending a 5-day quarantine versus the original 10-day quarantine for healthcare workers who contract COVID. They are able to return to work 5 days after the onset of symptoms, which lessens the duration of their absence, thus mitigating the shortage in any given department. 

Reasons Behind the Shortage

Staffing shortages are considerably more noticeable during the pandemic due to many factors including the influence of social media and news, and politics. Hospitals and other organizations have seen an increase in attrition due to the vaccine mandate, but not enough to create a massive dent in the operations of an entire organization. Many healthcare professionals are leaving for other reasons, such as burnout or better opportunities.

Burnout or exhaustion

Burnout or exhaustion can easily relate to the pandemic, as it places excessive stress on nurses and other healthcare professionals. Burnout can also relate to lower wages, less appreciation, and aging out of a job. The aging workforce sees many nurses working into their late 50s or 60s. 

Better job opportunity, moving, or retirement

Hospitals and ASCs are consistently recruiting and offering travel nurses amazing opportunities – which is appealing to many younger nurses or healthcare professionals who want to travel throughout the year to new places. 

Some healthcare professionals move due to a spouse’s new job or military deployment to a new station, or they simply want to retire from their demanding career. 

Demands of patients

The demands of an elderly patient are increasingly difficult, as they require more advanced and specialized care. As patients age, so do the nurses, and the work is tiring and repetitive. For many nurses, this links back to the burnout stage of their career. 

Not enough graduates

Many states have excellent nursing schools, but they just aren’t graduating enough nurses to fill the vacancies in many of the hospitals or ASCs. Some states struggle to meet even 50% of the vacancies for nurses.

Increase of COVID hospitalizations

The recent strains of COVID-19, including Omicron, are creating a high rate of hospitalizations, with many patients who are still unvaccinated. Healthcare professionals can be forced to isolate if they are infected or exposed to COVID, which results in the continuing shortage. The CDC is recommending hospitals and ASCs allow healthcare workers to return to work in 5 days if they contract COVID-19, which helps with critical shortages. 

Ultimately, the staffing crisis and shortages threaten patient safety, even in the face of wearing masks, washing hands, and social distancing. 

The Pay Problem

Rural hospitals and ASCs face the same challenges any facility faces with recruiting during a pandemic or staffing crisis – but rural organizations have one more challenge to face that others do not – their location, and their ability to match the pay of other local organizations that pay more for entry level positions.

Competing with retail

Rural towns and counties have the basic necessities for its residents – schools, churches, a hospital, banks, grocery stores, gas stations, movie theaters, clothing chains, and yes – even WalMart, the retail giant. WalMart can easily hire entry-level employees and pay $15 to $18 per hour, but hospitals struggle to retain employees as they aim to meet the pay rate with their local competitor. 

Hiring efforts

With specialized needs, such as licensed or certified technologists or nurses, it’s difficult for hospitals or ASCs in rural communities to hire without exceeding the competitor’s wages. Rural counties in states such as Nebraska, Wyoming, or Alaska must resort to sign-on bonuses for critical-hire positions, or relocation or moving reimbursement for new employees who move from out of state. 

Solutions to Staffing Shortages

These may seem like daunting problems that are insurmountable, but solutions are available with some effort and foresight: 

• Create value for your employees by teaching them new skills, such as a medical assistants learning the role of a scheduler or front desk staff
• Provide guaranteed coverage if an employee leaves the organization or is absent
• Develop a culture and work environment of trust and empowerment

Hospitals and ASCs in rural communities can also partner with management agencies to fill staffing gaps, or create better efficiency by shifting the focus of cases that the hospital is unable to handle because of over-capacity. 

Recruiting in rural communities is challenging at best – but with a focus on cross training new hires, or using intermittent or part-time staff, the stress caused by staffing shortages is relieved and full-time employees may stay longer with an organization. Quality employees and quality care starts with ensuring that your employees have a work environment and culture where they feel empowered, valued, and appreciated. 

Hiring managers should also focus on reviewing benefits packages and employee offers as they partner with their recruiting department. The relationship between recruiters and hiring managers is critical to ensure a smooth hiring process by bringing on qualified, talented professionals. 

The pandemic has created an increase in the employment of foreign nurses, who are subject to receiving work Visas that were otherwise intended for relatives of American citizens, but were canceled due to COVID-19. The number of available green cards for people moving to the United States for work doubled in the last year, so healthcare recruiters are hoping to gain from the opportunity to bring on foreign nurses to aid in the critical staffing shortages around the nation. 

What Coronis Health Can Do

Coronis Health is known and recognized for its medical billing and outsourcing for revenue cycle management (RCM). During this staffing crisis, think about how your facility is managing its billing or RCM, and how it contributes to your staffing woes. If you answer “Yes” to any – or all of the following questions, Coronis Health could be the solution to your staffing crisis:

• Are you short staffed because you are unable to pay or retain quality employees? 
• Do you have employees who are willing and able to cross train into other roles or departments?
• Do you have part-time opportunities but are unable to hire because you are currently overstaffed?
• Do you want to relieve employee stress caused by the pandemic?
• Do you need to streamline your billing processes or RCM?

Outsourcing your billing and RCM opens up multiple doors and opportunities for you to increase employee retention, relieve stress (caused by work demands or the pandemic), create more part-time opportunities, and streamline your revenue operation. You can maximize your revenue, increase your employee’s salaries, and ultimately retain the best talent for your organization. 

The pandemic is still here, and staffing shortages are still in crisis mode, but Coronis Health can be the light that creates a shining solution for your billing and staffing challenges. Call Coronis Health today, and see what solutions we can create for you. 

from
https://www.coronishealth.com/blog/struggling-with-staffing-shortages-we-can-help/

6 Mistakes You Might Be Making in Billing Management & How You Can Start Fixing Them

Billing management errors can cost you money and time. By identifying some of the problems you might be creating, you can find solutions that will strengthen your process and improve your bottom line. Check out these six mistakes you might be making in billing management and suggestions on how you can start fixing them. 

Poorly Thought Out Financial Policy

A poorly executed financial policy can mean you’re missing out on vital revenue and confusing patients. This lack of proper planning can shrink collections and cause AR headaches. 

By drafting a straightforward and easy-to-understand patient financial policy, you take a crucial step in the patient revenue cycle. It is an opportunity for a practice to communicate their financial expectations to the patient and document their understanding. The more knowledge, the better. 

Recommended Actions:

o Create a clear and precise policy that details collection processes and methods.

o Establish a financial billing agreement that all patients keep a payment method on file.

Inaccurately Collecting Patient Information

Whether you are billing an insurance provider or collecting payment from a patient, gathering accurate information is the first step of the process. Failing to collect all the patient information from the start of a visit can lead to time and money spent down the road. It also delays revenue as you try to chase down information from a patient. When you gather all necessary patient information upfront, you can avoid many mistakes along the way.

Recommended Actions:

Create a form that is easy to fill out (either hard copy or digital). It should include boxes for all the information you need from a patient to bill properly:

• Address
• Copy of driver’s license
• Cell phone
• E-mail
• Hardline phone

Additionally, you should:

• Obtain copy(s) (front & back) of insurance card(s)
• Obtain complete contact information
• Have payment option on file: CCOF – credit card or ACH
• Re-confirm contact info with recurrent patients

Failing to Follow-Up On Patient AR

Think of patient AR as another payer. Instead of contracting with the payers, you are contracting with each patient. A failure to take care of payment at the office visit means you have to follow up, wasting valuable and limited resources. And if you don’t have an automated system to send reminders, you’re going to miss out on revenue for services rendered. Meanwhile, your AR starts to grow. 

Recommended Actions:

• Add card reader machines at the check-in desk to eliminate wasted time keying in credit card information and provide instant verification.
• Enhance your collections process with the latest medical billing technologies, such as the automated revenue management tool, to set up reminders for payment.
• Keep credit card records for patients to speed up the payment process.

Not Having A “Click to Pay” Option

Patients always look for convenience, especially when paying a bill. To improve the patient experience and collect payments faster, create an easy payment process. Letting a patient know they can pay instantly online can alleviate many headaches. 

Recommended Actions:

• Add a simple but striking PAY HERE button directly on your homepage with a link to your pay portal to make payments easier for your patients. But make sure: 
  • It integrates with your practice management system for smooth payment posting.
  • Patients can self-update insurance or CC information within the link to pay.

Not Having A Collection Agency Policy

Many providers are cautious about utilizing a collection agency, as they want to protect their relationship with patients. But if patients are not making timely payments, a collection agency can help bring in expected revenue and set clear expectations with patients. A lack of a clear policy can lead to confusion, anger, and distrust from valued patients. 

We see many instances where customers follow up on unpaid balances once an agency sets clear expectations, thus minimizing the number of bills that agencies need to send to collections and increasing revenue.

Recommended Actions:

Create a clear policy that informs the customer that the services provided require in-office payment or the provider must take further action.

Poorly Trained Staff

When the efficiency and profitability of your revenue cycle are at stake, you need expert billers on your team to ensure your facility’s success. An untrained staff means coding mistakes, lack of AR follow-through, and declining collections, which costs you valuable revenue.

Recommended Actions:

Your staff will still need consistent training to stay up-to-date on the latest technologies and coding regulations.

• Lack of consistent training is an overlooked aspect in offices. Many staff members receive one-time training with no annual follow-up.
• Your processes are only as good as the people implementing them.
• Regular training will keep staff educated and allow you to share innovations.

Never miss a billing mistake again with Coronis Health’s billing management checklist.

Download Now

from
https://www.coronishealth.com/blog/6-mistakes-you-might-be-making-in-billing-management-how-you-can-start-fixing-them/

Affected by the Labor Shortage? Coronis Can Help

Health care facilities are under constant pressure to reduce costs and improve productivity—to do more with less. The increased demands and staff shortages brought about by the COVID-19 pandemic have further exacerbated an already challenging situation. 

In a tight health care labor market, your ability to maintain continuity of patient care with manageable staffing levels may be compromised. Coronis can help. We can evaluate your facility’s requirements and bring in the cost-effective talent you need in an efficient and scalable way.

What the Numbers Show

Hospitals are at the center of a national staffing shortage due to a combination of high COVID-19 patient volume and staff departures during the pandemic. Still, there is little national data available to quantify the shortages’ impact on patient care.

The first indication came in the form of a CDC report indicating that healthcare-associated infections would increase significantly in 2020 following years of steady decline. The researchers attributed the increase to pandemic-related challenges, such as staffing shortages and high patient volumes, which made it difficult for hospitals to follow standard infection control practices.

For example, the Joint Commission received 569 reports of sentinel events in the first six months of 2021, up from 437 in the first six months of 2020. However, meaningful conclusions about the events’ frequency and long-term trends cannot be drawn from the dataset. The Joint Commission estimates that fewer than 2% of all sentinel events are reported to the organization.

The Safety Impact of Labor Shortages

Nurses, physicians, and other health care professionals are leaders in patient safety. They’re the people who interact with patients daily—advocating for patient safety and making decisions and taking actions to promote safety.

There’s no doubt that workforce shortages in healthcare facilities can negatively impact patient safety. Research has found that labor shortages in hospitals exist across a broad range of occupations and specialties—from registered nurses and licensed practical nurses to respiratory therapists and paramedics. 

Improving the Revenue Cycle

Many healthcare organizations have adopted lean principles to lower costs, decrease waste, and improve the quality of care.

Tightening up revenue cycle management (RCM) is a crucial part of many lean initiatives. Improving the revenue cycle is not just a cost-cutting measure; it has the added benefit of increasing revenue to secure additional staff and resources. 

Revenue cycle management allows health care organizations to concentrate on improving efficiency so they can spend more money on attracting and retaining top talent. 

When you outsource routine RCM functions such as registration, billing, collections, denial management, coding, and insurance eligibility verification to Coronis, you can focus on hiring  only medical and clinical staff, rather than administrative staff as well. With fewer employees to manage, you can focus on your facility’s clinical needs rather than on financial pressures and performance, which your RCM partner can handle.

Outsourcing May Be Your Best Friend

No matter your line of work, competition is tough. This is especially true in the healthcare field. The system is already stressed, and with an aging population and a limited number of medical practitioners, the job market is becoming increasingly tight with higher demand and fewer resources.

This means that you may need to think outside the box regarding hiring practices. A viable alternative is to outsource certain functions if you feel that you can’t keep up with the growing workload or can’t keep up with the quality of care that patients deserve from your facility.

Outsourcing has become increasingly common in the healthcare industry. According to the Society for Human Resource Management (SHRM), most organizations decide to outsource work when they need help managing temporary or long-term workforce needs. 

This can be particularly beneficial during busy periods or if a company is experiencing staffing problems—such as those currently plaguing healthcare organizations everywhere. It also allows facilities to focus on patient care delivery rather than on administrative functions. 

By providing a range of services that can help alleviate stress for employees and increase overall productivity at your facility, outsourcing can address specific areas of concern. 

These services may include:

• Billing services  
• Coding 
• Collections and denial management
• Revenue cycle management
• System integration

Outsourcing these administrative functions may be a valuable strategy, enabling your facility to focus on its core operations and maintain patient safety in this tight labor market.

Partner With Coronis Health To Help Maintain Your Facility’s Quality of Care

Coronis is committed to supporting the frontline caregivers who work hard every day, every shift, to keep patients safe. 

Healthy finances lay the foundation for quality care. Our goal is to maximize your profits and reduce your administrative costs so you can continue providing quality care for your patients.

To receive your free financial checkup or to learn more about how we can help your facility in this demanding environment during these stressful times, contact Coronis Health today.

from
https://www.coronishealth.com/blog/affected-by-the-labor-shortage-coronis-can-help/

7 Signs You Need to Outsource

Medical billing is a complex process that requires the focus of skilled, certified billers and coders who are trained in the procedures that facilitate a healthy revenue cycle and prompt reimbursement for a healthcare facility. If you are struggling with timely filing, delays in receiving reimbursement, or staff burnout, you may need to consider outsourcing your medical billing. Here are the signs that may take you one step closer to outsourcing your medical billing and revenue cycle management. 

1. Strains on Your Administrative Staff

Healthcare is a dynamic, challenging industry, and requires a special team of highly trained clinicians and administrative personnel to accomplish many tasks related to patient care. Burnout is not uncommon in healthcare, and if your staff feel overworked or strained to complete their work, you will see a higher rate of turnover and dissatisfaction in your organization. Medical billing is not immune to turnover, as a facility’s focus on revenue-centered results places pressure on billers and coders to push high volumes of claims in shorter time frames, with a high level of accuracy. 

If you are seeing inconsistencies in your revenue cycle, such as issues with your accounts receivable (A/R), timely filing, or an increase in denials, you may have staff who are struggling to keep up with the demands of the work, and may choose to leave your organization. Hiring and training new staff is a costly affair, as you need to find the right fit – someone who is certified and highly trained, and can manage your expectations. Where revenue is concerned, you must set your expectations high, and the demands of your medical billing team will subsequently increase. Keeping a tight-knit billing staff in a facility is tough, so if you are feeling the strain of losing employees due to burnout, it may be time to choose an outsourced medical billing company that focuses solely on medical billing and coding – and nothing else. 

2. Delayed Payments

Healthcare facilities need prompt payment from medical claims to operate effectively, but if claims are not paid in a timely manner, the denied claim workload for your medical billing team increases and creates additional strain. Denied claims are the number one reason for a delay in payments, and could be related to several factors such as overworked staff – which can result in a high rate of billing or coding errors, or having to constantly train new clinicians or staff. 

The decision to outsource medical billing is a step in the right direction; you are choosing to have a group of highly trained professionals to take over your claims review process. By placing your trust in a medical billing company, you are facilitating success as your new medical billing company will ensure a high rate – as much as 99% – of clean claims, which significantly decreases the number of delayed payments. 

3. Decline in Clean Claims Percentage

Clean claims are simple to understand – they are a simple ratio – the average number of claims paid after the first submission. These claims are not stained by the delay of denials or long wait times in A/R, and the percentage should be 95% or higher. If your facility has a clean claims rate lower than 85%, your revenue cycle management strategy is lacking. Imagine 1,000 claims submitted, with only 850 paid after the first submission. This means 150 claims need to be reworked, rebilled, recoded, and resubmitted, which delays payment and could increase the number of days in your A/R as well. 

The percentage of your clean claims rate is a byproduct of the work your staff is completing, so the lower your percentage, the more time your staff is spending on reviewing denials, communicating with payers, and fixing errors before submitting a claim for the second time. 

Denials tell a compelling story about your revenue cycle management strategy. Your clean claims percentage could be telling you to re-write your strategy and outsource your medical billing. 

4. Diminished Revenue

Healthcare facilities have a tough decision regarding medical billing when opening the doors for the first time, as there is little revenue to cover the cost of adding a vendor. If your facility is well established and has a good stream of revenue, it might be time to consider outsourcing your medical billing. There comes a time when the billing process outgrows itself and eventually costs more to keep it in-house. 

The costs of outsourcing your medical billing could possibly equal the costs of keeping it in-house, but the better option is to move forward with outsourcing. An outside revenue cycle management company helps you convert the high, fixed employee costs to a variable expense that can be connected to revenue. Remember, if your revenue diminishes, you still have to pay your staff. Those expenses are fixed and cannot adjust with a loss in revenue.

Compare your revenue with the industry median; if you fall below the industry average, outsourcing could be the key to optimizing your revenue. A robust revenue cycle management strategy is an essential component of operational success for your facility, and ultimately reduces your operating costs.  

5. Struggles Keeping Up with Regulation Changes

The government and other organizations, such as the Centers for Medicare and Medicaid (CMS) dictate the rules and regulations for medical billing. New protocols are constantly introduced by CMS and other third party payers, so it’s critical to ensure that medical billers and coders are consistently updated on changes that affect the billing process. Predicting these changes is not easy, but the changes are inevitable and expected. 

Certified medical billers and coders in an outsourced company focus only on billing and coding, and are constantly updated on new information as it is disseminated by insurance payers and CMS. The information they receive ensures they remain compliant, are up to date on every regulation, and submit accurate, clean claims for your facility. 

6. More Time Spent in A/R

Your facility must understand the many reasons a claim is rejected, but closer attention is required for the number of days a payment is sitting in accounts receivable (A/R), where money due from a claim waits. Medical billers are required to submit claims on time, so a facility should expect that reimbursement would be distributed on time. It’s important to review A/R on a monthly basis to flag payments that are older than 30 days, but the larger your facility, the more difficult it becomes for your in-house medical billing staff to focus on the time spent in A/R. 

An outsourced medical billing company has teams that focus only on denials or A/R. Since they are not tasked with other facility responsibilities, the ability to track and manage A/R becomes less arduous. 

7. Lower Quality of Patient Care

When your staff are overworked and stressed, they will not deliver excellent, quality care to patients. Managing medical billing is complex enough, so adding to the plate with extra tasks such as scheduling appointments and interacting with patients adds to a biller’s workload, and reduces their ability to function at an optimal level. When this happens, a patient’s expectations are not met, quality care is absent, and patient satisfaction rates drop. 

Outsourcing medical billing takes the weight off your team. Let your staff focus on the main purpose of the facility – taking care of the patients, and let the outsourced company do what they know best – medical billing, coding, and managing your revenue cycle process.

Choosing Coronis Health for Your Billing Needs

Coronis Health combines years of expertise with a thirst for providing excellent customer service to ensure that your billing needs are addressed. We provide revenue cycle management services for laboratories and pathologists, behavioral health, hospitals and surgery centers, primary care and specialty physicians, FQHC and CHC services, anesthesia, and emergency medical services.

Additionally, Our team of certified billers and coders are dedicated to providing high quality services so you can focus on your patients. One of the best moves you can make for the revenue health of your facility is to outsource your medical billing or overall revenue cycle management process to Coronis Health. Contact us today for a financial checkup and find out why we are your solution to revenue cycle management. 

from
https://www.coronishealth.com/blog/7-signs-you-need-to-outsource/

Outsourcing Medical Billing: Benefits vs. Costs

Outsourcing medical billing may sound expensive, but the benefits can outweigh the costs. Let’s explore the real ROI on outsourcing medical billing – Coronis Health can provide tips to help you determine whether outsourcing is the right choice for your facility. 

5 Signs You Should Outsource Your Medical Billing

Medical billing is a critical component of your facility’s revenue cycle, as it ensures that you are earning the reimbursement from the submitted claims of the services you provide. If you are struggling with your accounts receivable, staffing, and an overall lower collection rate, you may need to consider outsourcing your medical billing. There are five significant signs that indicate a need to make the transition to outsourced medical billing.

Long Accounts Receivable

Accounts receivable (A/R) is money owed to your facility from an insurance payer; the key is to keep days in A/R less than 30 (ideally). The longer owed money sits in A/R, the longer your facility goes without receiving reimbursements. If your facility’s A/R is 45 days or more, this should be a reason to analyze the core reasons you are not collecting reimbursements or patient payments in a timely manner. 

Declining Revenue

Part of your revenue cycle is tied to your collection processes, and without a solid foundation of collecting on outstanding payments from insurance payers and patients, you will see a decline in your facility’s revenue. Coronis Health focuses on providing streamlined billing services for your facility to ensure that you experience an increase in revenue, rather than a decline in the lifeblood of your facility’s operations. 

Higher Operational Expenses

In-house medical billing is not just about reimbursement for services rendered – operational expenses are a critical component related to the cost of medical billing, which many facilities do not consider in the bigger picture of operations. The following factors contribute to a higher operational expense for a facility that uses in-house medical billing:

• Finding and hiring highly trained and certified billers and coders
• Paying hourly wages, which includes the employer share of taxes and employee benefits
• Licensing for software (depending on number of employees, you may be charged per license)
• Clearinghouse fees 
• Statement fees and postage, including the cost of printing
• Based on how many medical billers and/or coders you employ, a smaller billing department could be less productive and unable to handle the load of increased rejections and denials
• Decrease in collections and cash flow
• Increase in patient debt

These factors correlate with your facility’s ability to maintain a reasonable rate of operational expenses. When the costs of the above are factored into the cost savings of outsourcing your medical billing, you will discover that the increase in your net collections (your revenue) will surpass not only your previous operational expenses, but the fee you end up paying for your outsourcing. You end up making more in the long run. 

Lower Net Collection Rate

The net collection rate is the amount of money your facility collects on claims after excluding the adjustments applied by contractual agreements, however, denied claims factor into your net collection rate. An inexperienced medical biller, or a billing department with insufficient staff may write off denied claims instead of engaging in proper follow-up or resubmission of the claim. The rate at which this happens could decimate your facility’s revenue health. 

High Staff Turnover

Employee turnover relates to multiple factors, from job satisfaction to pay, but in medical billing, an organization may have a difficult time trying to find and keep certified medical billers and coders. This leaves billing departments short-staffed and pressured to keep up with mounting A/R and denial rates, correcting errors, and resubmitting claims.

The average length of employment for a medical biller is anywhere from 1 to 3 years, which means a higher rate of turnover for an organization. The cost of hiring and training has to be factored into the cost of operations, so a high rate of staff turnover is something to consider when determining if you will outsource your medical billing. 

Benefits of Outsourcing

One of the key benefits of outsourcing medical billing for your facility is the centralization and standardization of billing practices. Additionally, you will see a lower cost of operations, a decrease in billing mistakes, improved compliance, and above all else, happy patients. 

Lower Costs

Operational costs come with the territory of running a medical facility, but you want to keep them under control to ensure a healthy revenue stream. On average, most healthcare facilities can spend anywhere from 30 to 40 percent of their revenue on medical billing, but outsourcing this process significantly reduces operational costs. The money spent to train, recertify, and keep medical billers up to date on the latest regulations is an additional cost, and is eliminated when the billing process is outsourced. 

Fewer Mistakes

Billing errors can create a potentially large hit on your revenue. Errors include inefficient collection policies, incorrect coding, errors with patient registration and insurance verification, and lack of documentation with a claim. One mistake can result in a denied claim or delayed payment, and will ultimately result in continued mistakes with costly results. 

Medical billers specialize in many fields, from primary care to surgery, so it’s important to outsource with the right company that understands the intricacies of your facility. This ensures that you see fewer mistakes with billing, which means your net collections increase, your denials decrease, and your operational costs are more than manageable. 

Improved Compliance

Healthcare is a dynamic industry – regulations change to accommodate fluctuations with government requirements, insurance payers, and changes with technology and science. The Centers for Medicare and Medicaid (CMS) also implement strict guidelines for billing, so it’s important for a medical biller to be up to speed on changes that can affect the billing process for a facility. 

Certified medical billers and coders must learn and understand the regulations that govern how insurance payers reimburse, and how facilities must document to receive reimbursement. They are trained on how to apply coding that correlates correctly with clinical documentation, and are consistently updated on any changes that apply to coding or billing procedures. Outsourcing your medical billing ensures that you are working with a team that focuses 100% of their time on billing. You will see an improvement in compliance with billing regulations as your outsourced billing is following the guidelines set forth by the government and CMS. 

Happier Patients

Patient experience is an integral part of success in healthcare, as it signifies the quality, reputation and culture of the organization and its people. When patients are happy, there are multiple facets to that level of happiness, and it includes their perception of the billing process. A facility understands revenue cycle and everything it entails, but patients look at only what they can see – registration, insurance, what they have to pay up front, what they are billed, and their interactions with a billing department. When you keep your billing processes in-house, your support staff, which also includes your billers and coders, have responsibilities that extend to scheduling appointments, managing calls from patients, and other tasks that remove the focus from the purpose of their job – billing and coding. 

By outsourcing your facility’s medical billing, you are freeing up your staff to focus on creating the best experience for your patients. One of the most difficult aspects of keeping billing in-house is fielding the many phone calls related to patient bills, which sometimes involves more than just the billing department to resolve. Outsourcing medical billing gives your staff the ability to engage with patients without the stress of having to discuss a bill. With a better patient experience, you will see higher patient retention and satisfaction.

Outsourcing your billing services may seem like an expense your facility can’t afford, but in truth, it may be an investment your facility can’t live without. By outsourcing, you may find your revenue increases, your operations become more efficient, and your patients enjoy a higher level of care. 

Are you ready to take a closer look at outsourcing your medical billing? Let’s start a conversation. 

from
https://www.coronishealth.com/blog/outsourcing-medical-billing-benefits-vs-costs/