The Importance of Strong Revenue Cycle Management in Senior Healthcare Communities

Revenue cycle management support sounds like a mouthful, but it is a crucial part of maintaining long-term sustainability and capacity as a senior living and healthcare community. Revenue cycle management encompasses the financial process healthcare facilities use, from initial admission of a resident to the final payment of an outstanding balance.

The need for revenue cycle support occurs when trouble arises collecting accounts receivable. This is due to rejected or returned claims or delayed payments from Medicare, Medicaid or other insurers. A senior living management company can help perform or train community staff to perform revenue cycle tasks and can do so more efficiently, as they’re specialists in this area and in each of these payer types.

Revenue cycle management support includes, but is not limited to, five major areas:

• Customer service
  • Communicating with health insurance companies is a key component of revenue cycle management
• Billing and collections
  • Billing specialists ensure you’re submitting and properly coding bills to Medicare, Medicaid and any third-party payers or private insurance companies
• Payer contracting
  • Taking a close look at payer contracts for a provider allows for more timely payment and the ability to negotiate any uncertain terms
• Compliance with payer contract rules
  • Medicare and Medicaid specialists know how to code and help with an accounts receivable backlog
• Training
  • Now that your revenue cycle is in order, who will carry the torch? A preferred partner or consultant can handle the management of your revenue cycle, or train your staff to handle this internally

Each area is equally important and strong support in all five areas will ensure your long-term revenue cycle success. Utilizing the economies of scale of a senior living management company to handle your revenue cycle means you’ll have a full staff of experts in place to properly document, code and bill while maintaining compliance with payer contract rules. Your billings will be clean and accurate every time they go out the door!

Make your list, check it thrice

Hands-on, face-to-face training is very important when it comes to the revenue cycle. Having experienced billers and coders on staff remains a challenge in the senior living market. United Church Homes Management utilizes a robust, triple check process to ensure that the services we provide are properly documented, coded and billed for submission, while maintaining accuracy and compliance. This process makes certain that medical staff and the billing department are aligned on what is submitted to a payer. The last thing you ever want to do is submit an inaccurate, and therefore unintentionally fraudulent, bill.

Success in revenue cycle management comes in many forms:

• Having bills easily understood by residents and their families
• Reducing accounts receivable
• Reducing failed or returned claims
• Gaining access to payer contracts
• Improving billing accuracy to streamline reimbursements
• Improving cash flow with more accurate billing
• Training account managers or other internal staff to perform daily revenue cycle activities
• Achieving goals equal to or better than industry standards for cash collection (in the case of Medicare, payment in 14 days)

An example of revenue cycle support in skilled nursing

Picture this scenario. A resident is admitted to a healthcare facility and after an interdisciplinary care team assessment, a minimum data set (MDS) is recorded to an electronic file. This ensures there is data collected from admission through to final billing to keep track of any therapy, medications, medical supplies and other inputs that need to be coded for billing. An on-site team member, such as an MDS coordinator, handles all of this and a senior living management consultant reviews the process to ensure that all coding and interpretation of the resident’s needs are correct. The potential for fraud is high and therefore it’s critical to have this level of expertise in place.