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After months of post-pandemic recovery, health systems are starting to see the light at the end of the tunnel, according to one recent report. More specifically, emergency department (ED) visits are increasing, providers are spending more minutes in the operating room, and outpatient revenue is on the rise. This is all good news for hospitals that have been operating with razor thin profit margins over the last few years.
However, with increased patient volume comes the potential for other challenges such as revenue cycle management (RCM) staff burnout, claim denials, recoupments, and more. Hospitals must approach a growth in patient volume mindfully, so they don’t miss out on opportunities to maximize revenue, increase the operating margin, and avert potential revenue loss. Here are eight ways to do that:
- Document And Assess Chronic Conditions
- Validate And Update Demographic and Insurance Information
- Screen For Social Determinants of Health (SDOH)
- Provide Preventive Health Services
- Ramp Up Medical Coding Audits
- Provide RCM Support
- Ask For Patient Feedback
- Improve The Patient Financial Experience
1. Document and assess chronic conditions. To ensure accurate risk-adjusted payments, providers must address and document chronic conditions at least annually. As patient volumes increase—especially in the ED and hospital outpatient settings—it’s important for physicians to capture chronic conditions as well as update each patient’s problem list, document each diagnosis that’s part of the decision-making process, and describe the assessment of each problem during the visit. Without accurate and complete clinical documentation, countless revenue opportunities remain on the table.
2. Validate and update demographic and insurance information. With busier EDs and hospital outpatient clinics comes the potential for registration errors and omissions during the patient intake process. These errors and omissions can easily cause avoidable claim denials that disrupt cashflow. Training staff and monitoring key performance indicators are paramount, especially during times of increased patient volumes.
3. Screen for social determinants of health (SDOH). Addressing social determinants helps patients ultimately achieve positive health outcomes. It may also help reduce hospital readmissions and lower costs. The ED and hospital outpatient arena are opportune settings in which providers can screen for SDOH. In some cases, an SDOH assessment may even be a billable service even when providers perform it during an Annual Wellness Visit. Being on the lookout for opportunities to screen and assess SDOH helps maximize revenue.
4. Provide preventive health services. Most health plans, including Medicare, cover a set of preventive health services that help detect health problems and prevent certain diseases. Many of these services are billable and may even help hospitals generate incentive payments under Medicare’s Merit-based Incentive Payment System and similar value-based payment models. Leveraging ED and hospital outpatient visits to screen patients for various health risks or provide immunizations is paramount and can help maximize revenue.
5. Ramp up medical coding audits. As patient volumes increase, coding errors and omissions may go unnoticed unless hospitals have processes in place to monitor denial trends, perform ongoing audits, and provide proactive education.
6. Provide RCM support. All of these steps are only possible when hospitals have adequate, well-trained RCM staff. Given today’s pervasive and ongoing staffing shortages and healthcare staff burnout, it may make sense to partner with an outsource vendor that can handle one or more steps in the RCM workflow, including the critical steps of eligibility and benefit verification, prior authorization, medical coding and billing, payment posting, and accounts receivable follow-up. Without enough RCM staff—and the right staff—denials and long-term patient leakage may undermine revenue gains ushered in by short-term increases in patient volume.
7. Ask for patient feedback. Increased patient volumes provide invaluable touchpoints for feedback that organizations can use to improve patient attraction and retention, both of which bode well for long-term financial sustainability. This feedback—obtained during and after visits—also helps inform future investments in patient engagement technology, service lines, and more.
8. Improve the patient financial experience. Given the increased competition from healthcare disruptors in the ambulatory space, hospitals can differentiate themselves by providing a stellar financial experience that includes wraparound customer service support to enhance patient engagement and price transparency to build trust and reduce aging patient accounts receivable.
Looking ahead. With increased patient volumes comes the opportunity for increased revenue. However, it’s often not that simple, and organizations can’t necessarily bank on a 1:1 ratio. Instead, healthcare leaders must take a mindful approach to ensure the right RCM foundation is in place to support growth. Learn how Global Healthcare Resources can help.
