Revenue cycle management (RCM) for skilled nursing and long-term care facilities can be exceptionally challenging given the complexities of accounts payables and accounts receivables in the industry. Back office processes are often complex, requiring a team of highly specialized professionals to best manage proper cash flow at multiple facilities.
To achieve profitable results, operators must also familiarize themselves with how their organization can improve its revenue cycle management. Accounts receivables and collections require:
- Tracking every claim
- Fighting every denial
- Ensuring reimbursement
If your skilled nursing and long-term care facilities are going to be profitable, it’s essential to manage your revenue cycle with industry best practices. The revolving line of credit in skilled nursing is simply too inflexible to accommodate loose practices and can result in compounding problems in your revenue cycle.
Identifying Core Revenue Cycle Management Quality Measures That Require Improvement
There’s always room for improvement in RCM, and there are many aspects of the revenue cycle where problems can hide from your in-house administrators. Be proactive in identifying shortfalls in workflows including determining which quality measures to track. This will better guide your decisions and help you reach your operational goals.
Here are some of the various places to examine for improvement:
- Documentation workflows
- Coding practices
- Payer mix
- Accounts receivable by:
- Age by provider
- Claims denials
- Patient intake workflows
- Insurance eligibility and authorizations verification
- Cost-sharing collections
- Office visit workflows
- Coding and documenting diagnoses and procedures
- Claim editing processes
- Billing workflows
- Billing tasks
- Upload/download claim and remittance files
- Response to delayed or denied claims
Reminder: Complete and accurate data improves your facilities’ revenue cycle. Incomplete or inaccurate documentation creates problems and takes more time in the long run.
7 Ways the Revenue Cycle Process Can Be Improved for Long-Term Care Operators
Ways to improve the revenue cycle in healthcare for long-term care facilities include these seven strategies:
- Analyze and adjust your payer mix.
Evaluate how changes to your payer mix could positively impact revenue and better position your organization for survival through any storm. Ongoing review is required to ensure a healthy combination of revenue streams, allowing you to weather whatever adverse events come your way.
- Establish clean claims.
From prior authorizations and eligibility verification to referrals and documentation, you must verify everything is properly executed, in place, and performing just as it should. All of your pre-intake processes impact revenue.
- Ensure all claims are processed and paid.
We are confident you have many older, open accounts payable. Coordinate cash acceleration by concentrating on these outstanding claims. Do what it takes to collect—even if it means allocating more time and resources.
- Monitor metrics for potential issues.
Find patterns, track trends, and proactively mitigate potential problems. Examples of metrics to monitor include days service outstanding and cash collection rate.
- Watch the balance of private pay money.
Your operation must collect revenue to provide the best care possible for a private pay patient. Building strong, trusting relationships with private pay families becomes much easier.
- Eliminate barriers between the front and back office.
Too often, each end of the revenue cycle is siloed from the other. If your goal is to have a seamless cycle, it makes sense to decrease the segmentation so everyone can take ownership of outcomes.
- Outsource RCM.
The use of skilled professionals with subject matter expertise can reduce training costs, errors, and workloads on taxed staff. If you outsource back office solutions, hire a company with proven expertise in long-term care and skilled nursing, such as LTC Ally. You’ll see higher revenues quicker, and your patients will reap the rewards.
Revenue Cycle Management for Long-Term Care is Unique and Complex
Every long-term care organization faces unique challenges. When it comes to how to improve the revenue cycle in healthcare, few others have the acumen and experience of LTC Ally’s experts in RCM.
Many generic revenue cycle management systems were originally designed for short-term facilities. These designs were simply tweaked to be sold to long-term care facilities. However, long-term care and skilled nursing facilities have vastly different business models than short-term care and track distinctly different metrics.
Knowing how to manage the revenue cycle using a “tool” will cover the basics, but only grow your profitability so far.
Effectively managing the revenue cycle of long-term care organizations requires expert advisors that deliver the following benefits:
- Improved billing
- Recouped aged accounts
- Profitable rates and terms
- Expedited licensure and enrollments
Partner with RCM Professionals Who Know Long-Term Care
At LTC Ally, our founding is rooted in improving RCM practices by leveraging the most advanced technology available to improve practices and outcomes. Since 2006, we have developed streamlined processes tailored specifically to the long-term care industry’s needs. Our RCM teams are composed of highly trained specialists with a plethora of industry expertise.
Operators who partner with LTC Ally receive dedicated teams and support that act as extensions of your facilities, training staff and keeping administrators and operators in the loop. Our clients benefit from the full suite of services we offer, including controller and underwriting services, allowing your RCM to help support your growth strategies when it’s time to expand.