Reimbursement of claims has many areas of leakage potential in the revenue cycle process. The bottom line is positively impacted by the quick turnaround of the claims billed to payment received. There are many Key Performance Indicators (KPI’S) to look at to identify those areas that are slowing the collection process such as Days Sales Outstanding (DSO), Denial Rate, Denial Write offs, etc. One of the best ways to show positive impact to all KPI’s regarding revenue, is to apply process improvement initiatives to streamline the current processes.
Six Sigma is a project management methodology of reducing defects in a process. In revenue cycle, one of the major defects would be claims denied, as these stop or slow the cycle of receiving payments timely, which is the goal of revenue cycle. By using the DMAIC process, which stands for Define, Measure, Analyze, Improve, and Control, you can draw out and review the current state of the processes you are looking at and identify the areas of opportunity to improve.
The best area to improve with process improvement in the revenue cycle chain, is to streamline the front end, as this will reduce the re-work and potential errors downstream. Obtaining the correct information, the first time is a very important part of the revenue cycle process, as this is the earliest opportunity to prevent denials.
Clients of Integra will have the benefit of process improvement, with initiatives toward reducing defects along the lifecycle of the claims, till completion of payment. This approach will bring to the process, an eye for areas of improvement as we continue to look for areas of opportunity.
An example would be training the front end to provide the correct information in the beginning and creating a better process to obtain the necessary billing information, should we need to request it after the fact. This type of improvement, depending on the volume impacted, can have thousands of dollars impacted on smaller projects and bigger projects can impact in the hundreds of thousands of dollars. A laboratory that applied this methodology to this type of project saw a $100k increase in cash collections per year.
When the necessary information isn’t received in the beginning, a secondary process is needed to obtain correct information. This secondary process is slowing the revenue cycle process and possibly changing revenue into uncollectable write offs. Many payers have very short filing times and if the correct information is not obtained during the front-end process, we are many times at risk of running into filing time denials. It is essential to obtain correct information for claim submission, to mitigating timely filing denials.
Clients will benefit from having RCM organizations that are trained and have the tools to identify and implement a process improvement initiative. RCM organizations allow clients to streamline their revenue cycle by reducing rework, increasing revenue and save time on denials, so that resources can be applied to other opportunities for increased payment. Clients also benefit from RCM organizations to provide them with these resources and allow them to dedicate their time and resources to the patient. Ask us how Integra Connect can help you review your denials and implement areas of improvement.