3 Shift Revenue Cycle Operations Leads to 40% Increase in Collection Rate

 Erika Regulsky Billing & Collections, RCM

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3 Shift Strategy for Enhanced Revenue Cycle Operations and Collection Rates in Medical Billing

Efficient revenue cycle operations are crucial for healthcare organizations to ensure financial stability and maximize revenue generation. In this blog, we will explore the importance of revenue cycle operations in healthcare, with a particular focus on collection rates in medical billing. By implementing effective strategies and utilizing 3-shift revenue cycle operations, healthcare organizations can optimize their collection ratios and enhance their medical billing collection rates.

Understanding Revenue Cycle Operations in Healthcare

Revenue cycle operations encompass the entire process of generating revenue for healthcare organizations, from patient registration to final payment. This multifaceted process involves various stages, including patient eligibility verification, coding and billing, claims submission, payment processing, and accounts receivable management. Each step plays a vital role in ensuring a smooth and efficient revenue cycle.

The Significance of Collection Rates in Medical Billing

Collection rates serve as a key performance indicator (KPI) for healthcare organizations, reflecting their ability to collect payments for services rendered. A high collection rate indicates effective billing practices, prompt claims submission, and successful patient payment collections. Conversely, a low collection rate may indicate potential issues within the revenue cycle operations, such as claim denial management, delayed claims processing, or challenges in collecting patient payments.

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Importance of Collection Ratio in Medical Billing

The collection ratio in medical billing measures the effectiveness of an organization’s efforts to collect payments compared to the total charges billed. It quantifies the percentage of billed charges that the organization successfully collects. Monitoring the collection ratio is essential for evaluating the financial health and efficiency of the revenue cycle operations.

Implementing 3-Shift Revenue Cycle Operations

To maximize collection rates and streamline revenue cycle operations, healthcare organizations can leverage 3-shift revenue cycle operations. Let’s delve into each shift and explore the benefits they offer:

First Shift - 8:00 AM To 4:00 PM EST

During this shift, dedicated Accounts Receivable (AR) callers work within insurance carriers’ business hours to relentlessly follow up on unpaid claims, aiming to increase the medical billing collection rates. Maintaining strong relationships with insurance carriers ensures faster payment processing. Denial Management promptly addresses any denied claims within 24 to 36 hours, minimizing the impact on the collection ratio in medical billing. This proactive approach enables the organization to stay on top of denied claims and predict collections accurately.

Second Shift - 12:00 AM To 4:00 PM EST

In the second shift, the focus is on patient eligibility reporting and claim management, essential for optimizing medical billing collection rates. The team contacts insurance companies two days before patient visits to obtain detailed reports on eligibility, coverage, co-pays, deductibles, and preauthorization. This information is then incorporated into the Electronic Medical Record (EMR) system as alerts or provided to healthcare providers for better patient communication.

Additionally, specialty-specific certified coders review medical records, ensuring accurate medical coding and claims validation, which positively impacts the collection ratio in medical billing. Internal claim scrubbing is conducted to eliminate denials caused by patient ineligibility or coding errors, further improving the chances of successful claims processing.

Third Shift - 12:00 AM To 8:00 PM EST

The third shift extends into late evening hours to cover additional revenue cycle operations, including those related to medical billing collection rates. It allows for continuous monitoring of the revenue cycle, ensuring that all critical processes are addressed promptly. This includes activities like claims auditing by certified coders and thorough claim scrubbing to facilitate clean claim transmissions, contributing to an improved collection ratio in medical billing. Claims are transmitted within 12 to 24 hours, reducing delays and improving the reimbursement cycle, which positively impacts medical billing collection rates.

Benefits of 3-Shift Revenue Cycle Operations

By adopting a 3-shift revenue cycle operation, healthcare organizations can reap numerous benefits, including enhanced medical billing collection rates and an improved collection ratio in medical billing. These benefits are vital for financial stability and maximizing revenue.

Timely Claims Submission: Submitting claims within 24 hours minimizes the risk of rejections and denials due to late billing, thereby positively impacting the collection ratio in medical billing and overall medical billing collection rates.

Improved Clean Claim Rates: The meticulous review of medical records and proactive claim scrubbing improve clean claim rates, reducing the likelihood of denials related to medical coding errors or patient ineligibility, ultimately leading to higher medical billing collection rates.

Efficient Denial Management: Promptly addressing rejections and denials within the same day ensures timely resolution, preventing unnecessary delays in reimbursement and contributing to improved medical billing collection rates.

Accelerated Reimbursement: By streamlining the revenue cycle and ensuring timely claims submission, healthcare organizations can experience faster reimbursement, improving their cash flow and positively impacting medical billing collection rates.

Time to reinvent your revenue cycle operations

Optimizing revenue cycle operations and collection rates is essential for healthcare organizations to maintain financial stability and maximize revenue. The collection ratio in medical billing is a crucial KPI metric that reflects an organization’s effectiveness in collecting payments for services rendered. By implementing 3-shift revenue cycle operations and prioritizing strategies to improve medical billing collection rates, healthcare organizations can achieve greater financial success.

Remember, effective revenue cycle operations, along with a focus on the collection ratio in medical billing and medical billing collection rates, are the backbone of financial sustainability in healthcare. By prioritizing these aspects and continually improving their revenue cycle management strategies, healthcare organizations can not only optimize their financial performance but also deliver high-quality care to their patients.

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I’m a multi-certified revenue cycle management professional and compliance officer with 20+ years of experience. I contribute articles to leading healthcare publications and journals. I am currently working as Senior Transition Manager, in BillingParadise headquartered at Diamond Bar, California. BillingParadise offers Medical Billing Services that intersect perfectly with the EMR/Practice management system you use.BillingParadise has offices in New Jersey, New York, Florida, Georgia, Minnesota, and Texas.

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