Getting Paid Faster: Strategies to Improve Cash Flow Cycles

Multiple factors contribute to delays in practice reimbursement:

• Manual claim submission processes add time compared to electronic submission.
• Basic billing systems lack automation to catch errors before claim submission.
• Disorganized paperwork and missing details lead to payer follow up and return of claims.
• Lack of real-time eligibility checking results in coverage issues halting payment.
• Claims routing and assignment inefficiencies add to delays in payer processing.
• Denials and appeals caused by improper coding, lack of authorizations etc. prolong the cycle.
• Inefficient payment posting and cash application delays accounting recognition of received payments.

Any weaknesses across front-end processes like registration and authorization to back-end processes like payment reconciliation add days to the overall revenue cycle.

Drawn out insurance reimbursement cycles severely impacts practice success in multiple ways:

• Creates cash flow constraints – Delays in payment receipt strain ability to cover payroll, vendor bills and other operating expenses in the interim. This necessitates short term borrowing at added costs.
• Generates accounting inefficiencies – Long reimbursement cycles make it harder to accurately associate payments with services provided, compromising financial reports.
• Increases risk of bad debt – The longer it takes to get paid, the higher the likelihood of patients being unable to make their responsibility payments ultimately. This lowers net collections.
• Reduces investing capacity – Tying up funds in uncollected payments limits the ability to pursue investments in new technologies, staffing, facilities etc. aimed at propelling practice growth.
• Strains patient relations – When practices appear insensitive to patient cost concerns caused by untimely insurance payments, this reflects poorly on the provider brand.
• Impacts staff morale – Revenue uncertainty from elongated reimbursement cycles inhibits staff hiring and retention, taking a toll on practice culture.

Accelerating the speed of the medical revenue cycle delivers tangible financial and operational gains.

Key elements include:

Registration and Scheduling

• Verify eligibility in real time at patient check-in, and update expired policies to avoid denials. Integrate verification data directly into billing systems.
• Scan documentation like insurance cards to automatically capture in patient records for billing.
• Secure pre-authorization and referrals upfront for services requiring it to avoid payment delays.

Point of Care

• Clinicians review eligibility, coverage and financial responsibility with patients so they understand out-of-pocket costs.
• Discuss affordable payment plan options with under/uninsured patients. Execute payment agreements upfront.
• Complete clinical documentation like progress notes promptly to avoid claim delays later for pending documentation.

Coding and Billing

• Perform coding immediately upon visit completion based on physician documentation while details are fresh.
• Scrub claims electronically against medical policies before submission to catch errors.
• Automate recurring workflows like claims generation, submission, status tracking to accelerate speed.
• Resolve payer rejections through automation and exception workflows rather than manual rework.

Payment Posting

• Post payments to patient accounts electronically when EOBs are received to eliminate delays from manual posting.
• Automate payment plan rules and reminders to collect patient responsibility faster.
• Monitor staff performance on payments posting speed as a metric and implement competitions.

Continual optimization across the entire revenue cycle ultimately cumulatively improves payment speed.

Astute deployment of health IT systems streamlines traditionally manual workflows to drive faster payment:

• Patient engagement apps allow upfront online insurance eligibility verification and instant electronic copay collection.
• Integrated EHR-billing system eliminates claiming delays from bottlenecks transferring data between systems, especially with the use of Robotic Process Automation or RPA.
• Rules engine built into billing software identifies high risk claims pre-submission for correction to prevent denials.
• Automated scheduling tools ensure appropriate pre-authorizations are obtained based on payer requirements and patient benefits.
• Business process automation handles repetitive manual billing tasks like claims generation and submission to payers with no lags.
• Predictive analytics algorithms flag claims likely to be denied or delayed based on historical patterns so they can be proactively addressed.
• Intelligent payment posting bots accelerate applying insurance payments from EOBs to patient accounts automatically.

Advanced tools inject speed across the entirety of the medical revenue cycle.

Key metrics to monitor progress accelerating payments include:

• Eligibility verification rate – Verify insurance for higher % of patients on day of visit
• Point of service collections – Grow % of patients making payments for responsibility at check-in
• Time from service to claim submission – Decrease average time from patient visit to claim generation
• First pass acceptance rate – Increase % of clean claims paid without rejections
• Average days in AR – Reduce number of days between service and payment posting
• Denials rate – Lower % of submitted claims denied
• Time to payment receipt – Reduce days between claim submission and payment receipt
• Payment posting speed – Cut time needed for staff to manually post payments received

Analyzing metrics by payer, provider, office location etc. identifies opportunities to further optimize individual process components that contribute to overall payment lag.

Accelerating cash flow improvement initiatives necessitates addressing barriers like:

• Cultural resistance from staff unwilling to change from legacy manual processes. Engage staff through training and incentives.
• Lack of alignment between clinical and billing staff. Foster collaboration through cross-departmental teams focused on revenue cycle optimization.
• Difficulty justifying technology investments, despite long term benefits. Calculate ROI and non-financial gains through data-driven business case analysis.
• Integration limitations between disparate practice systems from multiple vendors. Assess API readiness and data interoperability pain points.
• Compliance concerns around new automated workflows. Involve compliance stakeholders early and implement appropriate guardrails.
• Sheer complexity involved in modifying many legacy workflows simultaneously. Prioritize addressing top bottlenecks first with staged rollouts.
• Lack of executive leadership engagement. Align faster payments to overall practice growth and care quality goals to secure buy-in.

While common challenges exist, proactive mitigation helps ensure expedited payment initiatives remain on track.

Here are your 10 key strategies that can significantly speed up practice payments:

1. Upgrade registration systems to enable real-time eligibility checking, documentation scanning, and pre-certifications.
2. Automate scheduling rules to track pending pre-authorizations by payer and service type.
3. Validate insurance coverage telephonically for high dollar services like surgeries before day of visit.
4. Offer patients multiple affordable online payment options before visit and at check-in.
5. Optimize EHR templates, workflows to capture key details for accurate coding like laterality, severity, supplies used etc.
6. Implement coding automation tools like computer-assisted coding to boost coder speed and accuracy.
7. Add intelligent claims editing tools to scrub electronic claims against current payer policies before submission.
8. Automate payment rules to post payments from ERA files and patient portal payments directly to billing system.
9. Use payment plan automation and text reminders to collect patient responsibility faster.
10. Create revenue cycle analytics dashboard to monitor key metrics by payer, provider and location.

A combination of technology, operations and staff education strategies ultimately expedites the collective set of workflows that span the entire revenue cycle.