Ten Drudgeries You Don’t Need To Do Anymore
There are two types of drudgeries:
- The kind you don’t need to do, but you do them because something will improve if you do. Think of a drudgery project like painting your house or apartment. A fresh painting will brighten things up (an improvement), but nothing terrible would happen if you didn’t paint.
- The kind you need to do because if you don’t, bad things can or will happen.
Unsurprisingly, we’ll name the second kind—the ten drudgeries you need to do—but then explain why you won’t need to do them.
1. Reading incoming faxes, ascertaining who the patients are and why and by whom they’ve been referred, then searching your database to see if records already exist, and if they do, attaching those faxes to the corresponding patient records.When referrals are for new patients, you’d need to create new records and then perform the same actions noted above.
The more faxes you receive, the greater the drudgery. But even a modest number of faxes can be draining.
Dealing with incoming faxes is a drudgery task that must be done, but not by you.
2. Calling referred patients to schedule their appointments because you don’t want to wait for them to call you. The first obstacle is getting the patient on the phone. When you finally do, there are the typical back-and-forths in arriving at a date/time that works for the patient.Proactively attempting to schedule appointments is essentially a must, but you don’t need to do it.
3. Getting prior authorizations (PAs) is one of the most infamous examples of a drudgery task that must be done unless you’re okay with providing services/treatments for free.First, it must be determined when PAs are needed. Then, you typically have to get them after spending hours of staff time trying to do so. And sometimes, they can’t be gotten.
PAs must be secured when needed, but you don’t have to do it.
4. Making sure you proactively know about out-of-network situations so neither you nor your patients are surprised.As with PAs, you have to identify out-of-network appointments so that one of two things can happen: (i) to see if you have any providers who’d be in-network for the appointment, or (ii) to invoke your in-house out-of-network financial policy for those appointments.
Ensuring out-of-network situations are either bypassed or are at least known about in advance can be time-consuming, but necessary to avoid unpleasantries later. But you don’t have to be ensuring it.
5. Figuring out what patients will owe after their appointments are completed can certainly be another drudgery-laden task. What are the charges for any one appointment? What’s being billed? What’s the deductible? What’s the copay? And then, what will the patient’s responsibility balance be? Now, multiply that effort for every appointment today.You’ll want the patient responsibility balance so you can prepare patients for what they’ll owe, or at least give them a very close estimate.
Calculating a patient's responsibility can be painful, but you don’t have to do it.
6. Trying to find out if patients with no insurance have it. Or, attempting to find missing insurance information when what you have is incomplete or partial. Would you be surprised and possibly shocked to learn that as many as 30% of patients without insurance have coverage?An accurate and automated insurance discovery option would do the trick without turning your staff into a detective agency.
7. Running in circles over HCC coding. First, many in healthcare don’t know what HCC is, let alone how to capitalize on it, which virtually any healthcare setting can.Hierarchical Condition Category coding involves a complicated set of elements, including risk assessments and adjustments. When used consistently and correctly, HCC coding drives revenue. Think of it as an added “boost” to your claims.
But humanly calculating HCC for every claim is daunting, perhaps almost impossible. What’s needed is an AI-driven EHR that can perform the calculations on the fly and produce the correct HCC codes as claims are created for added revenue.
8. Reminding patients about upcoming appointments and balances due. Both of these are critical for obvious reasons, but neither one requires human intervention if you have the automated options for doing them.Essentially, in the “set it and forget it” operation, your patients can receive interactive reminder texts for upcoming appointments and balances due. Presumably, they’d support a quick reply to confirm or cancel appointments and an online pay option for paying balances directly through those texts.
You’ll want this to keep your reception area busy and your patient receivables manageable without requiring staff intervention.
9. Dealing with EDI, including eligibility verifications, denial prevention, and EOB reconciliations.A “no-brainer” mechanism for automated eligibility verifications on scheduling appointments is a powerful way to alert patients immediately if there are problems. And no one actually has to do the verifications when they’re automated, as described.
Automated alerts on claims likely to be denied before those claims are submitted eliminates the need for staff to scrutinize each and every claim individually to determine if it will pass muster.
But you don’t just want “dumb” alerts; you want to see the edits needed.
Automated EOB reconciliations are self-explanatory: you want your payments posted correctly and ASAP to keep your A/R accurate to the minute, but without staff having to pore over them one by one.AI-driven automation covers these “must-do” tasks without you having to “do” them.
10. Compiling financial and operational analytics, KPIs, dashboards, and reports. This one’s a little different because you may want to do this. And you should be able to do so on demand, to the extent you want.On the other hand – and especially if you’re working with an outsourced RCM service – the service should compile the reports required for you to operate successfully, and their team should also review those reports with you regularly. (Still, you may want to create reports at any time. That must be allowable by the service; you must always have transparent access to all of your data.)
Compiling the data you need to thrive can be time-consuming. While you should be able to do it, it could also be offloaded in a user-defined fashion.
Bonus feature: if your specialty has personal injury patients (radiology, orthopedics, etc.) who have attorneys, a secure, self-service attorney portal enabling them to do much of their own work and look-ups would eliminate another drudgery task from your staff in dealing with attorney requests for which you derive no revenue.At the same time, a built-in attorney database neatly linking patients with their attorneys’ information would be helpful.
If you can empower your patients’ attorneys to self-serve, another time-consuming task will be significantly reduced, if not eliminated.
As you probably surmised, ADS and our MedicsCloud Suite for in-house automation and ADSRCM for outsourced services and staffing support the capabilities and options for eliminating “must-do” drudgery! Some of the items apply only to outsourcing with ADSRCM.
You can drive revenue, productivity, workflow, and clinical charting with ADS or ADSRCM! Contact us at 800-899-4237, Ext. 2264, or email info@adsc.com.
About Marc Klar
Marc has decades of experience in medical software sales, marketing, and management.
As Vice President of Marketing, Marc oversees the entire marketing effort for ADS (the MedicsCloud Suite) and ADS RCM (MedicsRCM).
Among other things, Marc enjoys writing (he’s had articles published), reading, cooking, and performing comedy which sometimes isn’t funny for him or his audience. An accomplished drummer, Marc has studied with some of the top jazz drummers in NYC, and he plays with two jazz big bands. Marc was in the 199th Army Band because the first 198 didn’t want him, and he has taught drumming at several music schools.
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