Revenue Cycle Management Is More Than Billing Patients

Revenue cycle management (RCM) is the lifeblood of any practice — private or nonprofit. Effective patient registration, insurance and benefit verification, charge capture, and claims processing are essential to maintaining practice viability. Before you can improve any process, you need to assess where you are now. Here are some questions you should think about:

• Do you know if you are achieving best practice standards in accounts-receivable management? • Does it take your practice too long to collect, and/or are your write-offs and adjustments too high? • Do you know your claim-denial rate on first submission (4 percent of claims or fewer is best practice)? • Have you determined that you are not leaving any money on the table with a reimbursement analysis? • What are your days in A/R? What percentage of your accounts receivable is more than 120 days old (10 percent or less is best practice)?

Patient registration The revenue cycle starts with patient registration. Patient registration begins with a phone call for an appointment request. Your front-desk staff should interview the patient on the phone to collect billing and insurance information;  invite the patient to go online to your website to complete their registration information; and follow up if registration isn't completed two days prior to the appointment — so that the patient's insurance coverage can be verified. You can use an in-office kiosk for patient check in and to collect demographic information. Some kiosks will automatically verify insurance eligibility too.  Charge capture Transferring patient charges from the EHR to your practice management (PM) system should be seamless — electronically transmitting data is an example of efficient workflow. But, if you are forcing your providers to first complete a paper visit-encounter form, and then transfer that information to the EHR, it can lead to inconsistencies, lost data, and redundant work processes. Furthermore, asking your check-out station to compare electronic patient information against the paper encounter form is burdensome and creates even more work when discrepancies arise.  Automatic payment posting Automatic payment posting can significantly reduce staff work, so why don't more billing staff embrace and drive implementation of auto-post opportunities? Holding tight to the status quo — manual payment posting and reconciliation — is an inefficient use of our most costly resource: staff. Routinely ask your payers, clearinghouses, and software vendors about new services coming online, and roll out every new payer as electronic remittance and auto-posting become available. Investigate a bank lockbox service that converts the paper explanation of benefits (EOBs) to electronic transactions (837s) for automatic posting to patient accounts.  Insurance eligibility verification Investigate and incorporate automatic insurance eligibility verification into your work flows. You can use your clearinghouse service to upload the appointment schedule a couple of days in advance, in a batch process. For walk-in patients, use real-time verification through your PM system. An integrated verification solution creates a history within the patient's record that supports follow-up collection efforts, if there are later discrepancies with the payer.

Article by Rosemarie Nelson - See more at: http://www.physicianspractice.com/billing-and-collections/revenue-cycle-management-more-billing-patients?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=29082013#sthash.Bbvb2ywQ.dpuf

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Four Areas to Review to Reduce Denied Medical Claims

Tracking your practice's denials is a fantastic idea. It helps you identify where your mistakes are occurring, so that you can update your internal policies and procedures accordingly. But, more importantly, there are several other areas that you can track to ensure that your denials continue to decrease. This shows that you are managing this area of your practice effectively.

There are at least four areas that you can review on a monthly basis that will ensure your denials will continue to decrease, they are:

1. Your charges out, your payments in, your adjustments and your percent collections.
It's not just the charges out and payments in. If your billing staff is making decisions to write off accounts without your knowledge, your adjustments percent will be higher than contractually necessary. Track this on a monthly basis and see how this will change.

2. Your billing register should tell you lots of information about your billing department. You will have your monthly charges, and the amount you actually billed out. The difference will be the number of re-bills completed. Your billing department rebills a claim when a correction has been made. A correction is driven from a denial. The number of rebills is a direct correlation to the number of denials.
You'll take the dollars billed out minus your monthly charges, and get your dollars rebilled.

3. Your paper denials are the next area to review. Conduct a physical count each month on how many of these paper denials come into your practice. This is complete transparency of your billing department.
Contractual adjustments are not denials, but if a therapist cannot code correctly, this is an area to review.

4. Electronic Explanation of Benefits (E-EOBs) is the next area. These are very similar in context to the paper denials, the E-EOBs reveal a lot of information that can help you review your systems and processes.
E-EOBs can be easily tracked by your billing department. An accurate hand count should be completed monthly.

The key to reviewing all of this information is to utilize the results in an effective manner. If you find that you are seeing a workers' compensation patient that has an out-of-state plan, they may not use the workers' compensation codes for your state. The best thing to do is to call the nurse-case manager and ask! Don't just write those off as un-collectable. Make a five-minute phone call and find out.


If you are managing an insurance contract that places a monetary cap on how much a patient can use for their medical treatment, adhere to that cap. When you exceed it, it is much less likely that you will be able to recover those claims. If there is any other visit limit, or number of times you can code a procedure within a year's time, find out when the front office performs the insurance verification.


There is a reason why insurance companies dominate the healthcare market, and small practices are going out of business. They bank on the fact you won't follow up. Make this a priority of yours, today.

Article By P.j. Cloud-moulds - See more at: http://www.physicianspractice.com/blog/four-areas-review-reduce-denied-medical-claims#sthash.8t9HvDwD.dpuf

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