QUALITY ASSURANCE AND DENIAL PREVENTION
Trajectory’s best practices include a stringent QA process on each claim. Most denials are due to simple clerical errors such as lack of authorization, missing or wrong patient ID, failed NCCI edits, etc. Through a standardized process for each common error, the human element is all but removed. This process is time consuming if not properly performed and can be tedious for the staff. Trajectory only hires staff that will buy into a less than 1% error rate, and places incentives on doing the job right the first time. These practices have resulted in a reduction in days in AR to a level which consistently grades in the top 10% in the country.
INCREASED REVENUE CAPTURE
One of the most important and overlooked areas to drive new cash is through documentation improvement. This is an area where we can produce positive revenue changes with no additional patients. It is also an area few of our competitors are interested in engaging. This sets Trajectory apart. This is where the money is made, and to ignore it has a major negative impact on the bottom line. It’s often said in healthcare, “if it isn’t documented, it didn’t happen.” This is especially true for billing. Trajectory will use metrics to determine where documentation holes may exist and perform chart reviews to isolate the anomaly. We will then work with providers to demonstrate the impact and suggest simple corrective action. This practice will result in an accurate portrayal of the patient’s acuity and the care provided, resulting in the highest possible reimbursement and the best possible quality indicators.
Self-pay collections are a focus of Trajectory. We divide these dollars into two buckets for reporting and tracking. The first bucket is totally uninsured patients who are responsible for the entire bill. This is an area where Trajectory works with client leadership to develop standardized processes appropriate for each provider. Some providers may want 100% collection up front and some may decide it is their desire to treat the indigent without questions asked. In either case, or anywhere in between, Trajectory can increase collections on true self-pay. A process for segmenting this population into those who can pay, who will pay, and those who have no ability to do so, allows for the proper patient-specific approach to each situation. These processes will lower days in AR, increase self-pay collections, decrease bad debt, and increase customer satisfaction.
The second bucket is patient responsibility after insurance. This is of growing concern to providers as co-payments and deductibles have risen drastically over recent years. These patients typically have the means to pay. Unfortunately, they are not all motivated to do so. With the use of front-end tools to determine likelihood of payment, Trajectory and its clients can choose a proactive approach to those who have an ability to pay but not a likelihood by requiring upfront payment. Those patients who have a lower ability but a high likelihood to pay can be offered payment plans if desired. All of these measures combined will increase collections after insurance, which can be as much as 50% of the total allowable and is of increasing importance.