Kick Start Your 2020 Revenue Cycle Using Three Simple Tasks
Posted on Thursday, December 19, 2019 3:44 PM
It’s well known in the healthcare industry that January 1st of every year takes the normal level of administrative activities to a new high, stressing your staff, frustrating your patients, increasing your staff payroll expense and finally, potentially impacting your cash flow negatively for one or more months. The reason for this flurry of activity, stress, and anxiety is that each year on January 1st, new or changing insurance coverage comes into effect for 90% of the insured population. This yearly activity can be mitigated significantly if a few easy, simple tasks are accelerated in the week or so prior to January 1st, allowing your business to run efficiently thru the New Year holiday.
Providers can prepare early for this influx of activity and avoid much of the stress and time delays after January 1st proactively by simply taking a few extra steps during the last weeks of the calendar year.
- Provide a list to assist established patients with insurance selection to be sure they have information regarding payors and plans that you do, and do not, accept or are contracted with. This is a simple step to both ensure the patient will not encounter a problem between calendar years and in addition, allows you to retain your patient base. There is nothing more frustrating (and potentially detrimental to you and your patient) than finding out after a patient’s plan has been chosen and locked in for the next calendar year, that the healthcare provider is no longer participating and treatment must be transitioned to another provider.
- Go a step further and provide the list to your referral sources as well, and ask for their list in return. Retaining and growing a patient base takes time and coordination with referring providers and taking the extra step to let your referring providers know what patients you are accepting from an insurance perspective will remove some of the work necessary to bring a patient into your agency. Your referring providers will thank you for this small favor that removes some of their work trying to coordinate with the patient, making it much easier for them to refer patients to you.
- Take note of the contracted payors and plans your referral sources are participating with on the list they’ve provided to you. Are there many overlaps where you both are contracted, or just a few? You may want to consider seeking out contracts with payors and plans that your larger referral sources already have and then communicating that back to them.
Another way to mitigate some of the activity that goes into post-New Year work is to begin gathering new insurance information and scanning copies of patient’s new insurance cards before December 31st. While some plans do have a delay in sending insurance cards out for new coverage, many of the plans have become better at mailing cards to patients so that they are received by the last week of December for a January 1st effective date. For existing patients, it makes sense to have staff reach out to your active patients to obtain the new coverage information and enter that information into the system so that once January 1st comes around, all that’s necessary is to inactivate old coverage and active the new coverage in your system. This reduces the amount of administrative burden and time spent updating routine demographic information amid all the other activities that go on at the first of the year.
Last, but certainly not least, reverify every active patient’s eligibility shortly after January 1st. Keep in mind that some payor enrollment lists aren’t updated until the second week of the month, so benefit changes, terminations and activations aren’t always accurate if you run batch eligibility of the first of the month. In fact, this is the worst day to run batch eligibility. Most payors have more accurate eligibility coverage information around the 5th of the month to accommodate employer updates into the system (known as retro terminations or coverage additions). Your EMR or billing system should generate a list of your active patients and allow you to do batch eligibility with your clearinghouse, taking care to ensure that the results are reviewed for patients whose eligibility comes back as inactive, and then storing the results of the eligibility check in your EMR system.
If you would like to discuss additional areas of your revenue cycle that you can also proactively address prior to the New Year rush, please contact Corridor today by clicking here.
Vice President of Revenue Management Services
Corridor is the nation’s preferred partner and trusted business advisor to home health and hospice providers, providing quality services and impactful results for 30 years. Focusing on key operational, regulatory and financial challenges, Corridor delivering industry-unique solutions and deep expertise in coding, clinical documentation review, compliance, billing and collections , consulting and provider staff education . At Corridor, we make the business of caring for people Better! For the most important industry updates and news that impacts home health and hospice, please make sure to sign up for our weekly newsletter to receive the latest up-to-date industry information direct to your inbox!
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