Patient Financial Services Challenges are No Picnic

August 17, 2017 By: Quadax

Utilizing tactics to plan for a picnic can translate into revenue cycle success as well.

Plan Well

Planning carefully for your picnic by thinking through each facet of the event helps to avoid mishaps, making the event more pleasant for you and for your guests. Then, turning one-time planning into a reusable picnic checklist will mean even easier preparation for your next al fresco adventure!

Thorough planning is critical, too, for operational efficiency in your business office. Documenting your plans and applying continuous improvement to them over time ensures ongoing success in areas like:

  • The efficient division of labor by balancing workload appropriately.
  • A file transfer schedule based on clearinghouse and payer acceptance cutoffs.
  • Programmatic automation for routine tasks.

Prep Ahead of Time

Great picnicking depends on doing as much advance preparation as possible. Food prep is a given, but also napkins rolled up individually with cutlery for easy distribution, and having insect repellent, sunscreen, wet wipes and adhesive bandages on hand.

In the PFS office, the work you do up front, before your claims drop, makes a huge difference in your ability to move claims to adjudication in the most cost-effective way possible. Don’t miss these critical advance prep steps:

  • Make sure that eligibility verification and medical necessity checks are being performed pre-service to avoid issues downstream.
  • Keep your payer table up to date in your EHR and in your clearinghouse software.
  • Configure auto-correct rules in your clearinghouse software to overcome known shortcomings in claim preparation by your EHR.

Keep it Easy to Eat

Balancing a plate of messy food (or failing to balance it!) can really distract from the pleasant picnic atmosphere. Serving food that’s contained – hand-held, even – is a great alternative. Calzones and empanadas are easy to transport and eat, and completely prepared in advance.

Establishing containment in your business office is a good way to stay organized and prevent the distraction—and wasted resource—of work duplication or inefficient procedures. Keep your processes in hand by taking advantage of:

  • Logical workflow, with well-defined work queues to keep specialists working their specialties with nothing falling through the cracks.
  • Electronic routing of worklists, with system notes added to facilitate collaboration when claims must be routed back to Medical Records or Utilization Review, for example.
  • Prioritized intervention based on expected reimbursement.

Prevent Spoilage

CousCous-SaladAvoiding problematic salads with mayo-based dressings is a great preventative measure; so is making use of sturdy sliced vegetables rather than tender butter or leaf lettuces that will fade in the heat. Grain-based dishes dressed with vinaigrette like this couscous salad or this gluten-free quinoa salad are tasty options less prone to spoilage.

The “spoilage” date for claims—per timely filing standards—varies by payer, so be sure that you and your staff know what the rules are, and where your claims are in each timeline. Helpful ways to keep track:

  • Configure your at-a-glance dashboard to include a snapshot of the age of your claims in active inventory.
  • Employ aging as a factor in your claim intervention prioritization by sorting workflow queues on the pertinent date (e.g. date of service).

Avoid Throwaways

Relying on disposable goods like paper plates for outdoor eating means unnecessarily disposing of cash as well as having more trash to deal with. Keeping a set of break-resistant plates, cutlery, and glasses in your picnic stash so they’re always ready when you are eliminates both problems.

Paper means extra expense in PFS, as well. Reduce your reliance on paper and realize time and cost savings with these tips:

  • Confirm that every payer able to receive claims electronically is configured as an electronic payer in your clearinghouse software payer table to avoid unnecessary paper submissions.
  • Make use of electronic claim attachments to cut down further on hardcopy claims.
  • Capitalize on your clearinghouse software’s ability to bring payer-rejected and denied claims back into your workflow electronically to eliminate working from paper reports or worklists.
  • Employ a system for converting paper remittances to electronic 835s.

Think “Double-duty”

Planning for double-duty service from the items you take cuts down on the load you need to haul. Cloth napkins and tea towels (for place mats) make for a festive picnic and are useful for padding while packing. A resealable bag filled with ice cubes serves as a cold pack as you travel with food, then the cubes may be used in the beverages you serve.

Thinking double-duty in your business office is a necessity to reduce your cost to collect. Make the most of your investment by taking advantage of everything your systems have to offer, for example:

  • Have comment records generated from your clearinghouse software to post claim modification tracking and status tracking back to your host system.
  • Configure a remits-for-posting folder with scripting to take ERA from your clearinghouse system for automated posting to your host system.
  • Allow your clearinghouse software to generate secondary and tertiary claims while processing remittance files, in order to automatically apply all primary payer remittance data required for coordination of benefits (COB).

Regardless of the similarities, of course, it probably seems a stretch to consider PFS a picnic. The challenges are real. Fortunately, so are the improvements that can be realized with these and other best practices for operational efficiency. Find out how Quadax can help—contact us today to request a consultation!

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