5 Things Impacting Your Revenue Cycle Right Now

The key to optimizing reimbursement, especially in the volatile world of behavioral health, is making sure you mitigate as many obstacles to maintaining a healthy revenue cycle. Here are five things that may be negatively impacting your revenue cycle right now.

1. Substandard Clinical Documentation – Now more than ever, payers are focusing on efficacy in treatment. Substandard clinical documentation prevents the payers from accurately assessing the client’s care, progress and future needs which can lead to denials, audits, recoupments and more.
2. Timely Filing of Medical Records and Appeals – Each payer has a different set of standards for timely filing and policies and procedures surrounding the appeals process. Understanding the limits, requirements and expectations of each payer is paramount to compliance with timely filing requirements.
3. Accurate Verification of Benefits – Often online verification of benefits can prove inaccurate and/or incomplete. Knowing exactly what information your facility needs to make informed admissions, financial and care decisions is vital to the health of your revenue cycle.
4. A Single Payer Saturated Census – Having one significant revenue stream can prove dangerous if that payer places you in audit, changes plan benefits, redefines their reimbursement methodology or makes changes to their requirements or medical necessity criteria.
5. Inflated or Inaccurate AR – Having an inflated AR means collectors are working and reworking paid, dead or invalid claims that draw them away from pursuing the newer healthy claims. Additionally an overinflated AR hinders accurate forecasting and business planning. Understanding your true worth is vital information for the sustainability and growth of your business.

Identifying key pain points and addressing them quickly can help revive your revenue cycle. Having an AR review and quality assurance process in place can help forecast and prevent unnecessary revenue slow downs .Working with an outside agency to help audit your AR can highlight challenges and present solutions and opportunities you may not have discovered on your own. In our next update we will address 5 things you can do right now to improve or revive a failing revenue cycle.

For more information on how PRRS, Inc. can help you identify and overcome challenges with your AR, Revenue Cycle and more visit us on the web at www.PRRSInc.com or call 1-888-405-3118 x 238.