Revenue Cycle Simplified: Top Tips for Better Billing and Admissions

By Maureen Hedrick, Director of Consulting Services
Richter Healthcare Consultants

It’s not always a good thing to make the Top 10 list, especially when it costs your organization money.  Billing errors are so easy to make.  According to Centers for Medicare and Medicaid Services (CMS), some of the top billing errors are easily avoided.  In this piece, we’ll discuss the most common mistakes that organizations make in billing and explore ways you can steer clear of them. 

Billing errors can impact more than your bottom line.  They can be the key focus of Federal audits.  The Office of the Inspector General (OIG) provides oversight of programs such as Medicare. Billing errors may be viewed as having potential for “Fraud and Abuse” of the Medicare program.  Providers may find that unintentional errors could be determined to be “abuse” and result in costly recoupments of monies previously paid, in addition to large financial penalties.  This is a major risk area for providers.  And, it’s a source of revenue for the government.  Currently, under these Federal audit programs, the government is able to recoup eight times more than what was paid to the provider in fines and penalties they assess. 

Admissions directors are busy people who juggle piles of information.  Some of them literally have stacks of paper to sift through when considering a new admission.  Was critical information scribbled on the paper notes the nurse took when she evaluated the patient in the hospital?  If it was entered into the system incorrectly, the billing department may not catch it.  You may not get paid. You may not get paid the correct amount.  Your payment may be delayed.  Few skilled nursing facilities can afford a delay or denial in payment. 

Gathering information during the intake/admissions process is important.  And, it’s critical to your business that it’s done correctly.  Gone are the days of wooing discharge planners and having gobs of time to plan an admission.  You might get the call at 10pm on a Saturday, asking you to admit someone being discharged from the emergency department of the hospital down the street.  What if you had that resident’s information already, before they arrived?  And, better yet, what if you could verify their insurance before they arrived? 

Not so long ago, family members had the opportunity to tour a facility prior to admission.  There was time for a meeting with the Admissions representative and for discussion about insurance coverages.  Family members brought insurance cards to be copied for “the file”.  The admissions staff had the luxury of time to determine coverage and limits, etc.  With technology, copies of cards are old news.  Insurance verifications can be done within minutes with the right tools. 

Guessing Game

Mrs. Smith’s daughter switched HMOs and forgot to tell you.  You bill the HMO in the file and find out her plan was changed.  You’ve lost precious time in your revenue cycle management. 

No more flying blindly!  Tools are available to help you identify potential problems with insurance eligibility automatically. I recently talked to a biller who typically spends about 45 minutes each time she has to call to verify eligibility. 

The odds are stacked against you unless you have some mechanism to check insurance eligibility regularly.  Technology can help.  By regularly checking insurance eligibility, you can shorten your revenue cycle by 30-60 days, have fewer billing errors and have more reliable cash flow.  Technology helps you, the provider, but also allows the family the security of knowing what charges are covered by insurance and what their responsibility is, enabling them to adequately plan for future care needs.

Upcoming Webinar – Dollars and Sense: Tips and Tricks for Shortening Your Revenue Cycle

I’ll be sharing more revenue cycle management tips during an upcoming webinar – Dollars and Sense: Tips and Tricks for Shortening Your Revenue Cycle.

Join me on February 25, 2015 at 2:00 p.m. ET to learn more about the best practices to avoid the most common billing errors. Secure your space now.


Maureen Hedrick has over 20 years of experience in revenue cycle management in the healthcare environment with a specialty expertise in long-term care and hospital reimbursement. In her role as Director of Consulting Services with Richter, Ms. Hedrick directs the internal Richter team responsible for consulting services provided to clients nationwide. Maureen is also the lead member of the Richter Audit team which provides training and consultation regarding the various federal billing compliance audit programs. Her client focus also includes strong expertise in billing and EHR software programs in use by LTC providers and she is a certified partner-trainer for PointClickCare. Maureen is a frequent presenter to professional associations and facility audiences.

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