Billing

The purpose of the hospital billing process is to obtain full reimbursement for services and items rendered by the facility. Reimbursement is received under unique payment terms from patients and third party payers including insurance carriers and government programs.

  • What percentage of your claims require human intervention to drop to billing?
  • Are all claims converted to 837 files and filed electronically?
  • Do you have a defined work flow driven by technology?
  • Do you have a secondary billing process in place?
  • How do you identify high risk areas needing education, QA and Competency Validation?

Billing

Business Issues

Despite having served the community with the best health services available, receiving complete reimbursement from a variety of payers operating under unique payment terms is not guaranteed, even when a facility has correctly performed all the steps required to submit an invoice or claim form (registration, posting charges to the patient's account, chart review and coding, etc).

Each facility manages a complex array of agreements with health insurance firms, government-funded programs, and individual payers. Matching authorizations, codings, and certifications to participating provider agreements and various payer guidelines and unique reimbursement systems and timelines introduces meaningful risk to timely cash collection and facility fitness.

Payer Guidelines

The billing process is made more complex by the wide variation in payer guidelines. These guidelines often affect the provision of patient services, the claim submission process, and the amount and/or timeliness of reimbursement. Compliance with these agreements is a condition for reimbursement and may include legal consequence from non-compliance.

Participating Provider Agreements

Most facilities work with various payers that provide coverage to patients including Medicare, Medicaid, TRICARE, worker's compensation, managed care programs, self-insured businesses, automobile insurance, and various heath insurance programs. Matching the services performed by facility staff to unique combinations of "Benefit Plans," "Customary Charges," "Covered Services," and the unique business processes of payers can become an ordeal for even the largest hospital.

Billing requirements too vary between payers regarding documentation, coding, claim for requirements, etc. Even the appeals processes can be very different.

Best Practices

  • DNFB should be <5 days of NPSR
  • Regular weekly meetings should be held with all department heads to ensure the most effective processes are being followed relative to bill holds, charge capture, timely coding, charge entry, timely review of billing rejection reports, and tracking feedback, and correction of rejection reasons
  • Complete insurance verification 3-5 days before date of service
  • Complete transcription within 24 hours of any procedure
  • Target claims billed out within 24-72 hours of procedure
  • Retain denial rates of 1-2%

Services

re|assess

Revenue Cycle Assessment

The revenue cycle challenges faced by hospitals today are enormous. Charge Capture, Coding, reimbursement and compliance issues plague larger facilities as well as rural and community hospitals. Resources to ensure appropriate reimbursement for services provided are stretched. re|assessre|solution’s revenue cycle assessment provides the foundation to optimize your revenue cycle and performance. <more>

re|source

Interim Staffing

Hospitals are constantly struggling with retaining qualified personnel (particularly with smaller community hospitals).  Replacing key personnel in the business office may require training existing personnel and establishing procedures and policies that enhance a new manager’s ability to perform.  Occasionally, locating a new employee takes time to find a good fit.  The facility may not have the luxury of reduced cash flow while recruiting takes place.  re|solution has qualified and experienced personnel ready on a moment’s notice to assist as Business Office Managers, Coders, Billers, Collectors and Cash Posters.  Business office interim staff are placed on-site for as long as they are needed. <more>

re|store

Insource Your Business Office

The regulatory atmosphere and relentless pressure of increasing complexity combine to create staggering challenges while introducing risk to your facility's ability to get paid for the services you are expected to deliver to the community.

  • Increased federal and state regulatory, oversight, and audit pressure continues to drain resources and cash from hospitals while these same agencies increase their focus on billing and coding compliance, often issuing stiff penalties
  • Reductions in reimbursement, increasing self-pay or higher deductibles combine to make cash collection critical
  • Revenue and cash collection are increasingly put at risk due to inadequately trained staff, the inability to afford the best technology and tools, and the struggle to implement and maintain best revenue cycle practices

Your facility has a significant investment in a billing system but does not have the personnel available to adequately manage and staff the business office under this ever-changing environment . re|solution performs all business office functions using your facility's existing billing software and utilizing a mix of your staff, our experienced personnel on-site and from one of our regional billing centers. This treatment is most effective in managing business office costs and relieving billing headaches, without the added expense of replacing your existing system. <more>

re|wind

System Conversion A/R Wind Down

Your new system conversion date is nearly here. You and your leadership team and staff have dedicated a large amount of time to implementation, planning and training while at the same time trying to maintain current operations. System implementations are complex and at times can be overwhelming, and despite your best efforts, key performance indicators can begin to move in the wrong direction. <more>

Benchmark

How does your facility compare nationally with other facilities of your respective size?

re|solution is an expert in rural, community, and critical access hospitals, providing superior accounts receivable management, revenue cycle analysis, training, charge capture reviews, interim staffing, and an array of other business office services.  If you are interested in knowing how the performance of your business office compares with demographically similar facilities and where your opportunities exist to increase CASH. Please complete the form below and return it to us by fax or e-mail.  In return, we will provide you with a free benchmarking analysis.  We will also make ourselves available for a discussion and explanation of the data. You may view a Sample Report.

Benchmark Indicator Analysis

Please click to complete the Benchmark Indicator Analysis online and we will return your results to you shortly. Your information is confidential.

If you prefer you may print and complete the form and Fax to (303) 847-0417 or e-mail to analysis@ereso.com.

Case Studies

Dallam-Harley Counties Hospital District increases cash and reduces expenses

In partnership with re|solution, Dallam Hartley deployed re|store™. re|solution placed a Revenue Cycle Manager onsite to assist with training current staff, securing additional staffing, stabilizing the DNFB and billing. The staff worked aggressively to meet milestone goals.

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