Billing compliance professionals are continuously faced with changing regulations, staffing challenges, and external agencies scrutinizing their every move along the way. Here, we take a quick look at the 5 most compelling and successful elements of compliance programs and break them down for you simply.
- If it’s not documented, it never happened.
As we know, if providers aren’t documenting services (correctly, of course!) then it’s impossible to get paid for it. What’s the key to managing this process? Education, education, education. We can’t say it enough – gather your data (proof) and have a regular cadence of communication with your providers on what they should be doing to consistently document with more accuracy. Replicate this effort with your coders; consistent monitoring of proper coding should help prevent over- and undercoding, which are both revenue killers in their own respect. Also, they consistently challenge billing compliance progress, so staying on top of your coders and providers steadily is key.
- Data is king.
In the case of billing compliance, never assume anything. Formulating an accurate depiction of a provider’s risk profile is paramount in understanding what corrective action to implement. Data is also vital in getting a 360-degree view of the organization’s overall financial health. Examining various data outputs including audit data, denial data, and external payer data will allow you to determine your areas of focus and modification.
- Work smarter, not harder.
If your current billing compliance technology stack isn’t working for you, it’s time to re-examine what you’re working with. Technology should be making you more efficient and effective at doing your job; it should complement your department and simplify workflows – not create more work for you. Also, something to consider is how many different types of software your organization is using. Can you be streamlining your stack by utilizing one robust platform instead of several that are needed to do the job of just one? Are different departments being siloed by the various software? These are questions you should be asking that will lead you to working smarter and not harder.
- Take a hybrid approach to mitigating your denials.
Traditionally, prospective audits have been common practice, but that process alone creates lots of work due to claims being held up, as each needs fixing before being submitted. Each of these claims sitting in A/R represents stalled revenue. Adding a retrospective approach to mitigating denials will allow you to learn from historical denial data and apply those insights proactively to address and fix denials. You’ll be able to uncover certain hotspots that can tell you why you’re being denied, as well as identifying issues within the system where auditors should be focusing. This critical info can be used to determine your prospective auditing process and helps save time so auditors can focus on provider education.
- Integrate your revenue cycle department in your processes.
One thing we tend to do is heavily focus on our job at hand. Because we’re so keen to stay within the bounds of compliance and conduct as many audits as possible, we often forget that other departments within the organization can benefit from and enhance our efforts. Revenue cycle departments face a common set of challenges as billing compliance. Both departments are plagued with constantly changing requirements, mandates, and financial goals. It simply makes sense to blend your efforts by sharing data, and creating a revenue integrity initiative so you have a much higher chance of detecting issues and resolving them more quickly. Creating a closed-loop process is vital to mitigating common risk areas for both departments.
Learn more about what billing compliance professionals are facing and the strategies to help mitigate these issues in our latest white paper on Healthcare Trends Impacting Revenue Integrity and Billing Compliance.
