It’s okay to expect more from your revenue cycle and accounts receivable management partners. Some are better than others, and others might be a better fit for you than what you have now. The important thing is to get out into the marketplace and see what’s out there.
Remember, these are your partners. A partnership is an arrangement where entities agree to cooperate to advance their mutual interests. A partnership commonly is formed between two or more organizations in which partners co-labor to achieve a common goal.
Here’s a checklist of qualities you should expect from your A/R partners:
1. Knowledge of best practices in the healthcare revenue cycle and accounts receivable management industry. Your partner should be well versed in the changing landscape of healthcare and understand the impact regulations and increased compliance requirements that affect your ultimate reimbursement rate. For example, they must understand what affect changing a pre-access process such as recovery of copay may have on your patient experience.
2. Strong IT resources focused on supporting revenue cycle management and accounts receivable (A/R) recovery. There are a variety of technological tools available, from automatic dialers to call recording systems, to make A/R partners more efficient. There are also multiple technology resources for electronic eligibility confirmation as well as electronic claim status updates that are becoming critical to assure maximum reimbursement from your third party payers. Make certain you know what those technologies are and, this is critical, do you want them used?
3. Skilled in handling all types of payers, from Medicare to Medicaid to Worker’s Compensation to insurers. Your A/R partner should not only be skilled and experienced in working with patients; they also must be skilled at finding reimbursement where it exists, when they can. For example, understanding maximum reimbursement rates for services with the coming of ICD-10 will be even more critical, as your partners will need to assist you in insuring that the services you provide are not getting denied under the new coding system.
4. Client service and support resources dedicated to answering client questions and providing information either about their own practices or the best practices of the industry. Is your Partner available at reasonable times and within a reasonable period to answer your questions or address issues? When working with partners in the earlier stages of your revenue cycle it is critical that there is daily and weekly operational communication with your team. Your partner should truly be an extension of your office and culture.
5. Technology that not only matches but expands the capabilities of the Provider, either because it would be cost prohibitive or not scalable. For example, one of the largest demographics of self pay A/R is people under 30. If your Partner doesn’t have an online system for payment, forget about resolving issue from this group. Does your Partner work directly on your system? If they are serving as a first-party representative of your organization, then the ability to work directly on your system is important for overall service levels. You and your partner then have minute to minute access to real-time updates, which creates total process transparency.
6. A/R staff with specialized training and certifications in healthcare. Does your partner have staff with the necessary certifications and knowledge of the healthcare industry? Staff who work with patients to resolve patient debt must have A/R training that is specific to healthcare. You’re A/R partner should provide training through technical certifications, continued industry education, and on-going developmental exercises. Technical certifications include the Certified Patient Account Technician (CPAT), Certified Clinic Account Technician (CCAT), and Hospital Financial Management Association Certified Revenue Cycle Representative (HFMA CRCR) exams, both accredited by the American Association of Healthcare Administration Management (AAHAM). In addition to the right training and certifications staff must be dedicated to your facility’s internal mission, values, and processes. Finally they have to possess the right aptitude and personality for the job; the ability to treat patients with unwavering compassion, dignity, and respect while meeting the needs of clients.
7. Reporting that serves or is customized for the client. Perhaps your organization uses a dashboard to distill reports for executives. Do the reports from your A/R partner arrive in a format or data standard that easily interfaces with your own reporting system? These reports should enhance and add to your current billing system reports by including production, disposition analysis, and trends of your aged receivables.
8. Knowledgeable and conversant on the latest industry trends. The regulations and laws covering healthcare A/R are undergoing a transformation. Is your A/R partner conversant with the changes to HIPAA, 501R, The Affordable Care Act? Are they CFPB aware and compliant?
9. Compliance with all laws and regulations. Any A/R partner will tell you that they are compliant, but can they prove it? Any professional A/R partner worth its salt will have a compliance staff who should be made available to you upon request and who should be able to answer specific questions regarding the company’s compliance with HIPAA and other healthcare regulations.
In our world, the world of healthcare A/R, it’s a dedicated single entity of work. We have time to spend with your patients. It’s not at the front desk with nine people waiting in line behind. It’s not like once a month when the statement comes out. It’s daily, weekly, hourly as needed. You want—no, you need to make certain that your A/R partner—management, staff, technology support—not only meets your expectations but exceeds them. You should expect no less.
Jim Christensen, owner and chief executive officer of Array Services Group and its family of companies, has over 40 years of revenue cycle and accounts receivable management experience in the healthcare industry.