Back to Basics for Revenue Cycle Clean-Up

basics cleaning revenue cycle

By Chris Kalish, Brittain-Kalish Group

There’s so much information available for fixing revenue cycle challenges, it’s hard to know what works best for your organization because most of your energy is spent just keeping the doors open. It’s true that optimal front end processes will make the life of your business office much easier. However, no matter how well you plan, train and provide process improvement opportunities, there are still activities required to clean-up the downstream portion of your revenue cycle. Let’s go back to basics that will help stop some of those leaks.

Always assess your data first.

Healthcare is a data rich industry, but using that data to make decisions can be a totally different story. Your data is your temperature gauge and can act as a map to help you in your business decision-making process.  The caveat is to decide what data is critical to your organizational success and only use that information. Using too much data or too many indices will give you information overload and you might not get anything accomplished.

Now you know what you are going to measure, so the next step is developing a clean-up team.

In developing the team, make sure they are clear about their goals. This means that they not only clear up the current problem and symptoms, but also the cause. As you assemble the team, don’t be too proud to ask for help. All organizations require additional interim resources at one time or another, since it’s difficult to work on the business and in the business at the same time. Your job is to keep the money moving. Just make sure you have a clear beginning and end to your clean-up process, addressing one issue at a time.

And last, but certainly not least, let’s go back to basics as you work the claims.

Prioritize your work queues and be ready to adjust quickly. Know what gives you the most significant effect and fastest return, which means go back to your data (See step 1). This might seem to be simple, but work your oldest, highest dollar claims first but balance that with those smaller claims that are high in volume, but might all have the same issues from the same payers.

Cleaning up the revenue cycle doesn’t mean reinventing the wheel. It just means going back to basics, using your data, developing a well-trained team and having a solid plan for working your claims. This becomes more and more important, as reimbursement mechanisms change and as we continue to feel the effects of ICD-10. The basics will keep you on the path every time.