The fiscal landscape of specialty groups such as physical therapy has changed over the years. The rise in operating expenses due to inflation and a sharp increase in labor costs are key challenges faced by specialty groups. And these challenges can limit growth in profits. Some specialty groups process multiple claims on behalf of a single patient.
Patients with complicated or chronic conditions receive care several times a week. Each visit constitutes a claim leading to a maze of claims to navigate through. This in slows down the revenue cycle and several claims fall through the system noiselessly even as providers struggle with tightening margins. Where do you turn to when the path to payment becomes increasingly fraught with uncertainty? Healthcare finance leaders have already figured out the answer- the revenue cycle.
The revenue cycle has transitioned from being a boring back-office function to a major process that can make or break the financial health of specialty groups. There are numerous moving parts and complex processes that make up the revenue cycle of healthcare organizations. One area of the revenue cycle that requires focus is the mid revenue cycle. It consists of a major chunk of the revenue cycle and optimizing it is vital to achieve stronger financial performance.
Payers utilize sophisticated algorithms to perform granular reviews of claims and more complexity and variables in the claim submission process result in higher denials. Most specialty groups see close to 30% of their claims being denied. All too often it is medical coding issues that lie at the heart of claim denials. Declining per-visit revenue and claim backlogs are signs of a medical coding issue. To ensure coding accuracy and compliance specialty groups must institute a coding quality audit program to reduce denials. KPIs should be monitored at periodic intervals to improve the coding process.
Charge integrity is essential for timely and optimal reimbursement of medical claims. Complete and accurate charges that are supported by clinical documentation improve compliance with industry mandates and maximize revenue. The industry benchmark for capturing charges is less than five days after the DOS (Date of service). Late charges contribute to revenue cycle lags and missed timely filing limits. To optimize the charge capture process specialty groups can make sure that charts are completed within 48 hours of a patient visit. This can prevent revenue leakage and downstream issues.
Payers require pristine documentation to reimburse claims. Documentation requirements have become more stringent and exacting. Medical coders oftentimes struggle to decipher physician notes and translate them into reimbursable codes. Standardizing the clinical documentation process and creating framework for physician notes add more strength to the clinical documentation process. Implementing a clinical documentation improvement program and fostering a culture of documentation accuracy vastly improves documentation quality.
Shifting payer mix and rising labor costs are backing specialty groups into a corner. We get that. At SolvEdge, we have the technology and expertise within our walls to infuse new energy into existing systems an processes. Achieve stronger financial performance with our certified revenue management experts. Our partnership models are unique and aligned to the needs of medical groups. We offer specialty-focused medical coding services and follow a technology agnostic approach.
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