Putting Out Revenue Cycle Fires
Thursday, August 16, 2018 | Nicole Knight
When I ask clients to define successful revenue cycle management, I get a variety of answers. Those answers are often related to the latest “dumpster fire” they experienced. And when I say dumpster fire, I mean: a chaotic or disastrously mishandled situation; the lack of planning, preparation or talent; or random events that effectively sabotage an effort. You get the picture.
Is “disastrous” the right word? Am I exaggerating? Not when it comes to revenue cycle management today. I have read a number of articles recently that state, based on the size and type of organization, an underperforming revenue cycle could leave up to $125 billion on the table for U.S. doctors each year.
Improving an underperforming revenue cycle will take some heavy lifting and attention to the details. It requires information, data and prioritizing the solutions. To reduce the number of revenue cycle fires you have to put out—and actually improve revenue cycle management—I suggest peeling back the layers to focus on these areas.
- Demographics and Insurance Verification – In most organizations the top reason for a denial is incorrect information. Verification of demographics and insurance starts with the first point of contact – scheduling, check-in, etc. Consistent processes are invaluable.
- Front-End Collections – Are you collecting all balances, co-pays and ABNs? With increasing out-of-pocket patient costs, this becomes more difficult. Are you tracking expected collections versus actual collections on the front end?
- Authorization Process – Do you find out after three months that a diagnostic test or invasive procedure has not been reimbursed because of no authorization? This is very common. A process to manage and follow-up on authorizations is key. Looking at resources, training, volume and re-work in this area on an ongoing basis will prevent needless loss of revenue.
- Charge Capture and Code Assignment – Financial success is directly dependent upon accurately coding and charging for services rendered. An effective charge capture program includes proper utilization of charge information, processes, and systems. Typically, when charges, coding and RVUs are questioned, we begin to look at the revenue cycle process. Avoid being reactive with effective charge capture, reconciliation and up-to-date coding processes in place. These processes should be evaluated routinely, and provider communication is essential.
- Denial Management – Find out the source/reason for the denial. Use this data to improve downstream processes. Less than 5% of claims should be denied on the first submission. Correcting patterns will result in improved collections.
- Measuring Key Performance Indicators – Are you measuring key performance indicators (KPIs) that reflect the health of your revenue cycle management? If not, you should be focused on key measures monthly. Staff productivity and quality metrics are important to ensure accuracy, and proper training, etc. Remember: what gets measured gets done!
In our increasingly challenging healthcare environment, it is essential to have a proactive approach to your revenue cycle…don’t wait for the next “dumpster fire” to deal with issues. Review your revenue cycle staff and processes on an ongoing basis to improve the financial health of your organization.
MedAxiom’s blog post is published every Thursday at www.medaxiom.com/blog
Illustration: Lee Sauer
About the Author
Nicole Knight, LPN, CPC, CCS-P, ACS-CA, is Vice President, Revenue Cycle Solutions and Consulting at MedAxiom. Her decades of hands-on health care experience includes cardiology and neurology practice operations, clinical management, business office management, and consulting for coding and compliance. Nicole maintains her LPN licensure in Louisiana and Florida. She is a member of the American Academy of Professional Coders and the American Health Information Management Association. She received her Advanced Coding Certification with the Board of Medical Specialty Coding. Nicole is a certified AHIMA ICD-10-CM Trainer and completed a Lean Sigma Healthcare training course at Johns Hopkins University. She also serves on the Physician Practice Council for AHIMA.
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