If you are a healthcare revenue cycle manager, you’ve probably asked yourself this question. Navigating the intricate landscape of the Department of Veterans Affairs can feel like a relentless maze. Complex filing requirements, tedious documentation, frequent denials and rejections, and state-specific regulations can be a headache for your already overstretched team. As a result, VA claims often end up on the back burner while revenue cycle teams instead prioritize Medicare and commercial claims. But even if VA claims make up just a fraction (1–3%) of your hospital revenue, that can add up to a sizable amount of money — money you don’t want to leave on the table.
5 Signs It’s Time to Outsource
Outsourcing your VA claim processing to a revenue cycle management (RCM) vendor could be the game-changer your team needs to turn that 1–3% into a powerful revenue stream. But recognizing the signs that it’s time for a strategic shift in RCM operations and outsourcing may be needed can be tricky. Here are five signs it may be time to outsource:
- High volume of denied claims: A significant increase in claim denials and rejections can indicate issues with coding accuracy, documentation, or adherence to VA guidelines. Outsourcing to a specialized vendor can address these issues, leading to a reduction in claim denials.
- Limited familiarity with VA policies: Staying up to date on VA policies and procedures is crucial for accurate billing — but the ever-changing rules and regulations make it difficult for busy teams to keep up. If your team lacks the necessary expertise in navigating the nuances of VA billing, outsourcing to a vendor with specific knowledge in this area can ensure compliance and minimize errors.
- Technology gaps: Outdated or incompatible billing systems can make processing VA claims inefficient and slow. Outsourcing to a vendor with advanced technology solutions can bridge these gaps and improve the overall efficiency of your revenue cycle operations.
- Patient dissatisfaction: Caring for those who have served our country is an immense privilege — and no provider wants a Veteran to walk away feeling dissatisfied with their care. Billing errors, delays in processing claims, or even a Veteran receiving an incorrect bill can negatively impact the patient experience. Outsourcing to a vendor with a strategic focus on accurate and timely billing can not only improve patient satisfaction, but also improve loyalty among the Veteran population you serve.
- Need for scalability: The MISSION Act of 2018 opened doors for Veterans to receive care outside of the VA. As the U.S. Veteran population continues to rise, the demand for care from Community Care Providers will also increase. Healthcare revenue cycle teams may face challenges in scaling their operations and managing VA claims. Outsourcing to a vendor can help your team adapt to changing volumes of VA claims.
4 Questions to Ask Potential RCM Vendors
When considering potential RCM vendors, ask these four questions.
- What is your level of experience and expertise? Ask how many years of experience the service provider has in handling VA claims processing, and confirm they have legal expertise in dealing with the VA.
- How familiar are you with the specific regulations and requirements set by the VA? Caring for Veterans is an immense privilege, but it comes with certain challenges. Regulations can vary from state to state, and the VA regularly updates their documentation and filing requirements. The service provider you choose must be familiar with these regulations and requirements—and have a team in place to monitor the changes.
- What type of technology infrastructure and software do you use for VA claims processing? Does the vendor’s technology offer robust analytics and automated workflows? Does the technology allow VA claims to be submitted electronically?
- Do you have case studies that showcase successful outcomes and client satisfaction? Results speak louder than words. Ask to see case studies that demonstrate the vendor’s ability to deliver needed revenue or references from satisfied clients.
Why Partnering With EnableComp Is the Smart Choice
At EnableComp, we understand that pursuing VA claims can be a challenge. We have the resources, legal expertise, and VA relationships to navigate the claims process for you. Here’s what you get when you partner with EnableComp:
- A “department down the hall.” We’re not just a vendor—we aim to be a true extension of your revenue cycle team, bringing you the resources and infrastructure to help you navigate the VA landscape.
- Legal support and expertise. Our team of VA-certified attorneys ensure compliance with the VA’s ever-changing rules and regulations. We also have strong working relationships with the VA, and they understand we have the training and knowledge to find solutions for our clients.
- Help processing all military claims. We even process Tricare claims.
- Cutting-edge technology. Our claims management technology, E360 RCM™, is the most comprehensive workflow engine in the marketplace. It takes the guesswork out of the claims process with built-in rules that identify what is required for each claim to be paid, how much should be paid, and the probability that the claim will be processed.
- Accelerated collections. Our clients experience accelerated collections, with 94% of VA collections occurring in the first 90 days of partnering with us.
- Increased uplift. We specialize in aged-out, zero-balance accounts. Our VA clients experience a 52% average uplift. That translates into millions of dollars.
Our results speak for themselves, with significant improvements in key measurements like days to pay, accelerated collections, and uplift. To learn more about how EnableComp can help you get paid for the work you do, schedule a consultation.
