February 11, 2016 – Whether your environment is for profit, not-for-profit, medical practice, clinic, etc. you are impacted by the efficiency of your revenue cycle management. Most simply stated, revenue cycle management means taking steps to ensure that you are able to bill for the services you provide, and get paid timely for the services you bill. The revenue cycle begins with the very first call a patient/consumer/client/person (patient) you serve makes to your office/clinic/agency and it ends when that same patient’s bill is paid in full. Every step along the way in this revenue cycle is crucial, but there are common practices among healthcare providers that are preventing your efforts from turning into cash:
Patient access and utilization
Patient satisfaction depends on a patient’s perception of the provider starting with the first touch-point. Problems during the intake process, scheduling, insurance verification and authorization can all lead to patient dissatisfaction, billing delays, excessive billing denials and constant rework – all of which can result in lost revenue. Most of the information necessary to generate an insurance claim is obtained during this first stage of the revenue cycle, and it is during this stage where most errors occur. Improvements to this stage of the revenue cycle should focus on these key processes and developing controls to insure accurate information is obtained prior to patient care to ensure most timely billing and collection.
Accurately charging for services controls the financial success of a healthcare provider. Most providers do not monitor charge integrity and validation because these activities are perceived as lower-level administrative functions and are not given priority. Providers do not understand the potential risks and negative financial impact of not capturing charges correctly. As a result, they have no idea what impact inaccurate charge has on their bottom line. Improvements to the charge capture process could include performing chart audits to test the completeness and accuracy of the charge process, and process improvements to stop leakage.
Billing, collections and denials management are costly processes to a healthcare provider. The provider should have processes in place for ensuring accurate and timely collections and for effectively managing the denials to keep the cost of these processes to a minimum.
There are many processes and controls a provider can implement to help monitor these stages of the revenue cycle. However, above all else, education of your staff is key. Consider how much money your organization loses because of inaccurate coding, treatment provided to ineligible patients, and treatment for services that are not covered. Add to that the real cost of rebilling and collecting denials – some estimates are such efforts cost companies upwards of $25 per claim. Every staff member should understand their role in the revenue cycle and how they impact the bottom line.
Dopkins has the knowledge and resources to help your practice achieve optimal Revenue Cycle Performance. With a focus on people, technology, and process improvement to enhance Revenue Cycle performance, we identify opportunities to strengthen the capture of revenue, to accelerate cash flow and to make the Revenue Cycle more efficient. Please contact Karen Costa at email@example.com for a discussion about your cycle and how we can assess and improve it..
About the Author
Karen D. Costa CPA
Karen, Assurance Services Director and Co-Leader of the Dopkins Not-for-Profit and Healthcare Teams, has lengthy experience with both for-profit and not-for-profit healthcare organizations specializing in auditing, revenue cycle consulting and certification of their Medicaid cost reports and specialized compliance audits.