As the year draws to a close, healthcare providers tend to look ahead and prepare for the upcoming year. This preparation can ensure your practice runs smoothly and efficiently. It can also help you identify areas for growth and consider how you can benefit from professional insights and services such as medical billing and coding, payor contracting, revenue cycle management, and more.
If you’re a healthcare provider, then taking a little time to go over the following items can help your administrative processes go more smoothly. Here’s a checklist for healthcare providers looking to wrap up the year and get ready for the next one.
Update Your Electronic Health Records (EHR) System
An efficient and reliable electronic health records (EHR) system is crucial to any modern healthcare provider. Ensuring it’s updated with the latest patient information and enhanced settings can lead to more effective operations at every level. Healthcare organizations can leverage EHR’s capabilities, such as reduced transcription costs, improved documentation, and automated coding, which not only streamline processes but also help cut down administrative costs and reduce medical errors. Take some time to speak with your medical records specialists and assess whether your EHR system is working for your needs. Consider switching or upgrading if needed.
Assess Your Claims Process
An efficient claims process is vital for the financial health of your practice. Errors in claim forms and medical coding can lead to significant revenue losses, as well as frustration for your patients. Implementing a system to manage insurance claims status is essential to identifying a denied claim, correcting errors, and resubmitting claims. EHR functionalities like procedure mapping and order sets can help automate and streamline this process. If you’re finding that revenue tends to get caught up in claim denials, take a second look at your medical coders’ workflow and resources – and consider outsourcing to reduce errors and get reimbursements faster.
Review Fee Schedule Changes
With the recent changes in the Medicare Fee Schedules for 2024, practices need to review it and adjust accordingly. The CMS has added new telehealth services and extended the payment for telephone evaluation and management services until the end of 2024. Make sure to take time to review these changes and ensure your appropriate staff are made aware.
Stay Updated with Coding and Documentation Changes
As medical billing and coding are integral parts of healthcare reimbursement, staying updated with any medical billing and coding changes is crucial. This includes being aware of the latest ICD-10-CM medical codes and ensuring accurate documentation in your medical record system. These changes to the current procedural terminology (CPT) don’t just include additions – some procedure codes have been deleted and your clinical documentation should reflect it. Ensure your medical billers assess these changes and update your medical records accordingly. If keeping up with these changes is too resource-intensive for your department, consider contracting with professional medical billing specialists.
Review Contract Renewal and Termination Notices
Review the renewal date and termination notice requirements of contracts with each health insurance company. Each contract has a specified date and notice requirement for making changes. Being aware of these dates ensures your practice has opportunities to renegotiate terms or make necessary adjustments well before you’re locked into another contract period. Assess whether you’re content with reimbursement rates for medical services rendered or denial management processes. If not, consider renegotiating or terminating contracts for a more competitive rate. This task requires careful attention to detail and understanding of contract language. Setting reminders or using a calendar system to track these critical dates can be helpful. Having trouble negotiating more favorable contracts? Look into working with a healthcare contract manager who can support you and make you aware of any changes or possible better rates.
Understand Restrictions on Charge Increases
Practices need to be aware of any restrictions or limitations on increasing charges. These restrictions can vary depending on payor contracts and local regulations. Being informed about these limitations ensures your practice remains compliant while optimizing its revenue. Regularly reviewing payor contracts and staying updated with local healthcare regulations can help you understand these restrictions. It’s a balancing act between maximizing revenue and staying within legal and contractual boundaries. Keep in mind that being found not compliant can have a severe negative impact on your revenue cycle management, so take extra time to assess whether you’re on track. A healthcare industry contractor can help you stay abreast of any local regulations you may be missing.
Understand Notice Requirements for New Services
Understanding notice requirements is vital if your practice plans to introduce new medical services in 2024. These requirements are often necessary for being eligible to submit medical claims to health insurance companies for these services. It’s like informing the relevant parties before hosting a big event; it ensures everything runs smoothly. If you plan to introduce new healthcare services this year or in the near future, reassess these requirements and plan accordingly. Keeping a checklist of these requirements and following up diligently can ensure that your practice stays compliant and gets all potential revenue from healthcare services. Payor contracting experts can typically help facilitate these notice requirements by maintaining good relationships with your payors and ensuring these processes go smoothly.
Update Directories and Contact Info
If your practice is expanding to new locations, meeting the notice requirements for these changes is essential. This involves updating directories and informing payors, which helps maintain an accurate and up-to-date presence. Think of it as updating your address book; it ensures your contacts have the correct information to reach you. Regular reviews of directories and communication channels help ensure that the data remains current and accurate, reflecting the true scope and reach of your practice. It’s also invaluable to your patients – take time to review your online presence and ensure your contact information is up-to-date on your website, Google listing, and more.
Review Your Medical Coding and Billing Practices
Medical billing and coding is one of the most essential departments in any healthcare facility. It ensures that health insurance companies can quickly and properly process claims and reimburse you for services. Look for any hiccups or pain points within your medical coding department and ask for feedback from your medical billers. If your billing process is draining your resources, look for ways to streamline it, or consider contracting with a medical billing and coding firm to cut costs and ensure a smoother process.
Review Your Insurance Verification and Prior Authorization Processes
Getting caught up in insurance verification or prior authorizations can cause undue frustration for your patients – even before they receive services. Speak with your front office and administrative staff to locate any pain points around these processes and look at ways you can smooth any wrinkles. If you don’t have it already consider implementing ways patients can upload insurance information online before their appointment, allowing your staff to collaborate with the patient’s insurance company well ahead of time. At the same time, consider digitizing patient registration and the patient’s medical records by having them uploaded ahead of time, too.
Examine Patient Collections
Patient bills that aren’t paid can add up when it comes to your revenue cycle. Take a look at your collections process and look for ways to better communicate the patient’s financial responsibility. Consider adding ways to make it easier for patients to pay their medical bills like online portals or through a patient account app. Also consider implementing education for your team on value-based approaches such as more detailed cost estimates, insurance coverage, and itemized form.
Look for Leaks in Your Healthcare Revenue Cycle
The end of the year is a great time to assess the overall financial health of your practice. Look for leaks and find areas where you can benefit from a healthcare industry contractor. Whether it’s help with medical claims, payor contracting, claim denial management, medical billing and coding, credentialing, and more, you may be able to upgrade the efficiency and financial return of your practice by outsourcing some of these administrative tasks. And if you’re not sure where to start? The right healthcare industry expert can help you look for leaks and recommend the right steps.
Connect with PayrHealth
These year-end tasks are crucial for your practice’s smooth functioning and growth. By taking these steps, you can ensure you’re well-prepared for the challenges and opportunities of the new year. If you’re hoping to meet goals and grow your practice this year, consider partnering with a contractor who specializes in helping healthcare providers become the best in their area.
Navigating the complexities of our healthcare system isn’t something you need to do alone. There are real costs to not doing it optimally. Reach out to PayrHealth to learn how our experts can support your organization.