Our last blog post kicked off a series focusing on some adjustments rural hospitals can make within workflows for improved financial performance. Rural hospitals are a critical part of our healthcare ecosystem as they represent the only care option for many US citizens within reasonable driving distances. According to a recent Becker’s article, from 2007 to 2018 nearly half of census areas in the South had diminished hospital access. And the areas affected most were those with higher populations of people of color. This is a subject deserving attention from industry and political leaders.
While today our attention turns to mid-cycle strategies, I highly recommend checking out our front-end advice in our first post. Feel free to start here though. Luckily, this is revenue cycle and not a Star Wars story.
Care management is critical for optimizing hospital resources, remaining compliant and driving success at the middle stage of the revenue cycle. Without an operational framework driving thorough review and coordination of care, inappropriate bed usage and length of stay will increase as will denials.
Here are some care management approaches you may want to consider implementing if you haven’t already:
When it comes to CDI, it’s critical to get support and buy-in from the operations side largely in control of it, and the clinical side. An effective way to accomplish this is by creating a physician advisory role, or team, who can facilitate the needed improvements uncovered post-visit.
Once an effective leadership team is established, it’s imperative to monitor effectiveness by tracking high impact KPIs such as:
Ensuring that claim submissions and denial appeals are submitted within contracted filing windows can be low hanging fruit to positively impact reimbursement rates. Educating staff on specific payer deadlines is an effective start. However, creating steps within daily workflows that drive awareness and intentionality is what really matters. Here are some additional tasks and software add-ins to consider:
According to the American Medical Association (AMA), late claim submissions account for approximately 10% of all claim denials.
In a collective effort, these adjustments can help rural hospitals navigate financial challenges, improve patient care, and sustain their vital role in serving communities with limited healthcare access. As a part of HCM’s partnership with rural hospitals and medical centers, we work to define and achieve goals together. Lending to our approach of bridging the gap, our expertise enables us to identify opportunities within workflow issues and resource needs to fine-tune what can be executed upon with HCM.
In the third and final installment of our Rural Hospital Best Practices series, we’ll explore best practices around Billing, Collections and Denial Management.
Meanwhile, if you are struggling with mid-cycle financial performance, HCM can offer direct support or host a free best practice discussion by heading to our contact page.
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