In today’s healthcare landscape, operating margins are slim, and patient price transparency is more important than ever. A well-optimized revenue cycle is critical to maximizing insurance payment collection and reducing burdensome patient payments, while maintaining a healthy bottom line.
In a previous Trexin Insight Paper, No Margin, No Mission, I discussed the multi-faceted approach to Revenue Cycle Management (RCM) Optimization. In this paper, we will take a deeper look at one of those optimization opportunities, starting at the front end: Decentralizing registration-related charge review edits to registrars and front-end staff.
BENEFITS OF DECENTRALIZING REGISTRATION-RELATED CHARGE REVIEW
Decentralizing registration-related charge edits to front-end staff and registrars improves coder and charge efficiency, and incentivizes front-end staff to collect accurate registration information up front.
By routing all registration-related edits to workqueues for front-end staff, you can reduce manual messaging back and forth between coders and registrars. Registration staff have a discrete list of edits to be worked, and can sort by the criteria that matters most, whether it’s highest dollar or oldest accounts.
These registration edits can also be worked concurrently while coders are resolving coding-owned errors, keeping workflows streamlined to the key parties involved.
In the long term, working the same top-hitting registration edits encourages front-end staff to collect key information from the patient when they arrive for their appointment, reducing the number of registration-owned edits on the back-end.
KEYS TO SUCCESS
While decentralizing charge review workqueues creates efficiency, there are a few key steps that must be taken in order for it to be successful. These include training, accountability, and leveraging reporting insights for process improvement.
Most of the actual resolution steps on registration-owned charge review edits occur on registration screens, with which registration staff are already familiar. Charge review workqueues where the charge session and edits live, however, may be new to registration staff. Confirm that your registration staff receive all necessary training on charge review workqueues, and have support staff available to answer questions on charge session review and resubmission.
With all charge review workqueues, clearly identifying workqueue owners creates accountability. Make sure that registration-owned workqueues are owned by registration staff, not the coding team. Aligning workqueue ownership to the staff responsible for working the queue is critical for monitoring and progress. Assign your registration-related charge review workqueues to patient access managers who can oversee the work being done by their staff, and encourage resolution in a timely manner.
Clear workqueue and edit ownership is also crucial to segmenting your dashboard and Key Performance Indicator (KPI) reports to identify trends and opportunities for registration workflow improvement and to assess effectiveness of decentralization.
LEVERAGE REPORTING INSIGHTS FOR PROCESS IMPROVEMENT
As with all other aspects of the revenue cycle, reviewing top edits and identifying opportunities for improvement leads to a healthier revenue cycle, and quicker payments. Leverage reporting insights to improve processes by monitoring KPIs and dashboards, and identifying upstream workflow improvement opportunities.
As part of a thorough reporting and dashboard review program, review your top-hitting registration charge review edits and monitor how they change over time. Regularly working the same top registration-related errors can indicate a workflow opportunity to add soft or hard stops within the registration workflow to reduce the edit from occurring and increase the speed with which the claim gets out the door.
KEY PERFORMANCE INDICATORS (KPIs)
Successful implementation of decentralized registration-owned charge review edits should show a decrease in Pre-AR Days, an eventual decrease in Pre-AR owned by Registration, and decrease in Registration-Related Claim Edits and Denials.
There’s no one-size-fits-all Revenue Cycle Management Optimization program. Decentralizing registration-owned charge review can create efficiencies, and also needs support and monitoring to be successful. Through a strong partnership between Electronic Health Record (EHR) IT staff and revenue cycle operations and leadership, organizations can continue to identify opportunities to improve their revenue cycle health.
Interested in learning more, or want advice on how to get started with decentralizing registration-owned charge review edits? Trexin can help.