4 Ways quality assurance can improve operations in post-acute care
By: Ronda Howard, Vice President Revenue Cycle and CAHPS, HEALTHCAREfirst
In post-acute care, quality assurance for revenue cycle is important because everything you do will impact how you’re reimbursed on the claim as well as your patient outcomes — and it all comes down to process flow. Every single step of the care journey must flow correctly for the service to become a claim, for that claim to go to the payor, for that payor to process the claim correctly, and for payment to reach the agency. Quality assurance helps to make that ripple effect more efficient and more accurate, ultimately helping to speed up revenue and reduce denials.
Revenue cycle has a lot of moving parts — clinicians schedule home visits, see patients, and enter documentation. Patient intake involves determining insurance coverage and what services need to be performed. Then care teams need to communicate with physicians and retrieve required documentation. Quality assurance examines those separate processes to see where they can be made more efficient or more accurate and where redundant steps can be eliminated.
Agencies rely on reimbursement to add services, buy products, and support their patients. The more you do on the front end to help ensure quality, the smoother (and faster) your reimbursement process will be. In this blog, we explore four ways quality assurance can improve your operations and ultimately your revenue cycle.
Reports can identify errors before claims go out. Why is a service not billing? By running a report out of the EMR, quality assurance teams can view any errors or issues and let the agency know how they can be corrected.
Process flow reviews can reveal what’s broken. When processes are not flowing as they should, such as an agency not getting paid or payors not receiving claims, quality assurance teams review existing flows to identify what’s not working and how to fix it in a way that removes the burden from staff.
Taking time to make process changes can improve operations. It’s common for staff to be so busy and overburdened with manual tasks that they struggle to take the time to create better process flows. But once those new workflows are in place, tasks can be more efficient, less cumbersome, and involve fewer man hours.
End goals help to guide agencies toward improvement. Are your current processes achieving the end result you expect? If accuracy is currently at 50%, then quality assurance teams go to the drawing board and figure out what needs to be done to get it up to 95 or 99% accuracy.
In the end, quality assurance is all about checking in on a regular basis, measuring process outcomes, and determining how it can be done more efficiently. This happens at implementation and beyond — continuing to identify areas for improvement, setting clear goals, and creating meaningful process flows that impact operations. Communicating and keeping an open dialogue with everyone involved is key to understanding pain points and what needs to work better.
Schedule a demo with MatrixCare today to learn how our quality assurance process can help your agency meet — or even exceed — your business goals.
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