SURVEY REVEALS REVENUE CYCLE OBSTACLES
A recent survey by HIMSS (Healthcare Information and Management Systems Society) lists payer denials, reimbursement issues and obtaining prior authorization among the top challenges facing providers today.
The survey quizzed leaders across the U.S. in revenue cycle, finance and reimbursement roles in hospitals and acute care facilities. The top three challenges cited by nearly half of the survey respondents in order were payer denials, problems obtaining reimbursement and prior authorization.
Additionally, respondents noted that the root causes of their challenges included clinical documentation and coding issues, limited budgets for technology or additional staff, competing projects taking priority and proving return on investment when implementing processes or technology to improve these problem areas.
HOLLIS COBB OFFERS SOLUTIONS
Listening to our clients is vital in learning how our team can best serve their needs, and that is what has led us to develop services that keep pace with the ever changing challenges revenue cycle leaders face every day. Before the HIMSS survey identified these three problem areas, Hollis Cobb already had solutions in place as a result of listening to our clients and developing ways to assist and support them as they strive to improve their processes and their revenue.
Appealing Denials
Hollis Cobb’s Insurance Recovery Department includes a denials team that works daily assignments from clients. The team accesses work queues directly in the clients’ systems, has access to payer sites as well and works denials in conjunction with each client’s team. Our team has been highly successful overturning first level appeals for our clients enabling them to focus on their more complicated second level appeals. Additionally, Hollis Cobb provides regular ROI reports to our clients detailing our fee compared to dollars recovered by our team, showing our clients the return on their investment.
Insurance Follow-Up
Our clients are plagued by payer requests for additional information, coding reviews and other follow up on submitted claims. This piece of the revenue cycle is extremely time consuming, particularly for smaller balance claims. The Hollis Cobb Insurance Recovery Department is staffed with experts who have many years of experience communicating with payers, processing their many diverse requests and working directly in client systems. Our staff can document directly in the client system, or our IT department can provide a daily note file to update the client system on our daily progress. We work as an extension of our clients’ insurance teams and operate according to all client guidelines.
Prior Authorizations
Hollis Cobb has a large Pre-Auth Department located at our main office in Atlanta. That team has an excellent track record of obtaining pre-authorizations for our clients in numbers that exceed our clients’ target goals. Our staff works directly in our clients’ systems and assists the patients with skill and professionalism. This department has grown tremendously over the last five years with the expansion of insurance plans available for more Americans. Additionally, Hollis Cobb can place Pre-Auth staff onsite at client offices; however most clients prefer that we work out of our office, allowing them to use their office space for other staff.
As more challenges arise in the healthcare revenue cycle arena, the innovative leaders at Hollis Cobb continue to look for creative ways to help our clients maintain healthy revenues along with a positive patient experience in the communities they serve.
