It’s that time of year again…summer is ending, vacations are behind us, and school has returned. While there is no such thing as a lull in our demanding industry, early fall is one of those few periods we don’t typically have added pressures from our normal routine. So, back to school is a good time annually to get Back to the Basics and focus on fundamentals and verifying operational processes. Below is a Back to the Basics checklist of items that are imperative in ensuring an efficient and effective revenue cycle system exist and are at times under-valued.

1. Review of Workflow and Processes
   Consider a refresher training of the system and workflows for your team. It might be surprising how many team members are missing a step in the appropriate workflow. These missteps can lead to rework by registration, coding, and billing leading to delays in claim submission and subsequently cash collections. Refresher trainings to ensure all team members understand and are actively
   following the workflow will help to minimize claims errors and denials. This review will also help in identifying any redundancies or missing steps that need to be addressed.
2. Timely-filing, Timely-appeals and Prior Authorization Grid
   Prior Authorization information could include which payors require authorizations, web-links to current requirements, required timeframes, and how to request an authorization. For example, request via fax versus request via web portal. In addition to Patient Access and clinic staff, don’t forget to include Utilization Management. Back to the Basics MS Chapter of HFMA · Mississippi Headlines · Aug/Sept 2022
   A Timely-filing and Timely-appeals for all payors. This should include information such as timely filing
   guidelines for primary claims, secondary claims, corrected claims, and appeals listed in an easy-to-read reference grid. While many providers have these grids, it’s not uncommon for these grids to be outdated due to payors frequently changing their policies and procedures.
3. Insurance Card
   A review of sample claims to see if insurance card copies are being captured at each visit. The accounts
   should also be reviewed to see if the patients are then being correctly registered in the correct insurance / plan code. This would also include whether the insurance is correctly identified as primary or secondary. This review can often surface training issues or a clean-up of the insurance / plan codes. This includes deleting redundant or unused insurance / plan codes and ensuring the descriptions seen by front-end staff match the current insurance cards.
4. Eligibility Return Review
   A review of sample eligibility verifications to see if staff are reading the Eligibility Return correctly. This
   would include identifying the managed Medicare plans correctly and not as Original Medicare. This would
   also include identifying products correctly as primary versus secondary.
5. Provider Manuals and Payor Updates
   A routine review of provider manuals for updates and changes and to reinforce payor policy and procedures with staff is crucial to the revenue cycle. Payors update their policies regularly and often these updates are not discovered until denials are received. Having a designated review period and a process to ensure these updates are pushed out to the relevant revenue cycle teams and departments will decrease denials, reduce cost to collect and shorten the cash cycle. Back to the Basics MS Chapter of HFMA · Mississippi Headlines · Aug/Sept 2022
6. Denial Review Against Front-End Edits
   Avoiding denials is any revenue cycle team’s top priority; however, having zero denials is inevitable. A systematic review of historical denials to identify opportunities to increase the clean claims rate helps identify process improvements that may have been overlooked. One way is to compare your Electronic Health Record and/or Clearing House front edits against denials. This can help identify front-end edits that are misfiring or the need for new front-end edits to prevent denials. As providers, we place a large focus on automating processes using technology and data analytics. However, given the complexity and ever-changing rules in our industry, people will always be a key part of a successful revenue cycle system. Given such, it’s always good to incorporate a routine review into your processes. If you don’t already have a systematic review of your processes, scheduling at least an annual review of getting Back to the Basics will help validate your processes are working as intended.