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The Dos and Don’ts of Revenue Cycle Management

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As a healthcare provider, you’re very likely already familiar with the importance of a well-managed and orchestrated revenue cycle. Having your revenue cycle optimized can make the difference between a profitable, financially stable practice and a failing business. There are many common mistakes that can lead to your reimbursement being held up or never fulfilled. In this piece, we will attempt to lay out some of these hurdles and provide tips for properly managing your revenue cycle.

The Revenue Cycle

The revenue cycle is an eight step process in which you, the healthcare provider, need to dot all the i’s and cross all the t’s. Doing this in the proper order and at the proper time ensures you are getting reimbursed for your services.

Step One: Preregistration

This step is arguably the most important. By preregistering your patients you can ensure they have the coverage, prior authorizations if needed, and eligibility needed to reimburse you for your services. It also allows you to collect their information to start an account for the patient, complete with medical histories and health insurance coverage. This step is very important to get everything correct, as it will be the basis for your entire revenue cycle with this patient.

Step Two: Registration

Once the patient has made it into your practice, the registration process continues. This is your opportunity to verify and correct any patient information you gathered from preregistration as well as obtain copies of insurance cards and photo ID from the patient.  This is when you would also collect the patients copay.

Step Three: Charge Capture

During the exam you need to record what services are provided and charge for them accordingly. There are two methods for doing this and both have their advantages and disadvantages. Which method your practice uses is not as important as the underlying problem, making certain you are not missing any charges you should be billing for. Missing and miscoded charges result in a loss of revenue which could be easily avoided. Speak with an experienced advisor to ensure your practice is charging what it should be for your services.

Step Four: Claim Submission

This is the process of submitting your charge claims in order to be paid by the patient’s insurer. There are several things which can go wrong here, delaying your payment. Your claims should be “scrubbed,” in order to ensure for accuracy, so they will be paid in a timely manner. “Dirty” claims will slow down your revenue cycle and delay your reimbursement. Another key part of this step is checking the transmission report. The transmission report shows claims sent, claims returned, and claims dropped. The rejections report will identify any incorrect codes. By reviewing these errors you can correct and resubmit the claim immediately. Covering this sooner rather than later makes for a more robust revenue cycle.

Step Five: Remittance Processing

This step has several pitfalls which can lead to your revenue cycle decreasing, or your practice not getting reimbursed for all services rendered. Things to avoid which can hurt your revenue cycle include but are not limited to: Not reviewing your remittances for errors, you could be leaving money on the table. Other ways of leaving money on the table during the remittance processing step can be: Failure to review your fee schedules annually, ensuring they are up to date with any changes made to adjusting rates, contracts, and allowables.

Step Six: Insurance Follow-up

This step in the revenue cycle is like checking your revenue cycle bucket for holes and leaks. By carefully inspecting and going through your accounts receivable, you can determine where and how your process is at risk, as well as where and how your practice may be able to tighten up. This way you are more likely to be properly compensated by insurers and patients.

Step Seven: Patient Collections

Easily the most problematic component of the revenue cycle is collecting money from your patients. Having trained staff at check-in and check-out procedures can minimize this. Sending monthly statements to your patients with outstanding bills is a good way to suggest they set up a payment schedule, one that works for both the practice and the patient. If you can avoid bill collectors, it is always preferable, again, for both the practice and the patient.

Step Eight: Medical Service Review and Value-Based Care

As more insurers move to a value-based care system, it is important that your practice reviews its processes in order to improve the level of care provided, as well as inefficiencies within the system. Be sure to analyze clinical treatment data to find ways to lower your expenses, maximize resources, and improve your patients’ health outcomes. Analyze the medical necessity of treatments, along with the best course of care for your patient.

Optimize Your Revenue Cycle with a Management Service

At Sullivan Management and Consulting Group, we understand the complexities of owning and operating your own medical practice, because we have worked practices within the industry for over twenty years.  In that time, we have witnessed many changes to the laws and regulations relevant to this ever-changing field. With our years of experience assisting and supporting practices just like yours, you will worry less about the headaches of optimizing your revenue cycle, allowing you to focus on patients and the practice of medicine you love.

Click here to schedule an appointment to learn what else the Sullivan Management and Consulting Group can do for your practice, or give us a call at 832-323-3691 to discuss your revenue cycle optimization.

author avatar
Brad Petak