• Four Keys to Successful Revenue Cycle Management

    May 3, 2017 | Kevin Kasmar
  • Here we share our top four revenue cycle management best practices, and they aren't necessarily what you'd expect...

    Front Desk Experts

    The first point of contact for all patients is the person who is scheduling their appointment. Therefore, your receptionist should have expert knowledge in:

    • all of the Practice's in-network insurance companies
    • requesting and completing all essential patient information
    • scheduling patients for maximum profit
    • ensuring each patient's benefits are verified before their first appointment

    Knowing who the practice is in network with reduces the amount of time spent verifying benefits for patients who do not wish to use their out-of-network benefits. Collecting all pertinent information at the time of the phone call (i.e. Name, Date of Birth, SS#, Address, and Insurance Information) eases the amount of time necessary to check-in a new patient on the date of service and makes verifying benefits much easier. If a patient has trouble giving out the SS#, REMEMBER, you cannot collect easily without it and this is, at its core, a financial agreement between your patient and your practice. Once the benefits are verified, make sure to collect all co-pays and deductibles at the time of service. Patients are not motivated to pay for their care after treatment is complete; this can fast lead to high A/R balances.

    Detail-Oriented Therapists

    The second key to creating a successful financial picture is the practitioner. All insurance companies and federal regulations require that medical records contain certain documentation. These include:

    • Patient Verification Elements
    • Proper ICD-10 Coding
    • Time Spent
    • Current Issues
    • Measurements
    • Goals
    • Correct CPT selection

    These components are essential for the therapist to complete. An insurance company can ask at any time for patient medical documentation and refuse or retract payment based on the information received.  If the practitioner understands what the insurance company is looking for, they can significantly reduce denials and payment delays.

    Therapy-Specific Billing Experts

    The third principal factor for any practice is a having Revenue Cycle Management team. Your billing and collection partners will make sure the claims are clean and include all pertinent information:

    • Claims should be sent out within one to two days of being received
    • the clearing house should be monitored for errors
    • all payments should be posted accurately
    • and the A/R report should follow the collection protocol

    Most claims will pay without issue, but there are always exceptions. The billing and collections team should benchmark and strive for 34 gross days in the A/R accounts, no more than 10% of claims in 120+days, 10% between 90-120 days, 30% between 30-60 days, and 40% in current. These percentages will change from month-to-month based on current payor mix, so be sure to average when collecting data!

    Once the claims have processed, it is time to collect from patients on denied claims and/or patient share that wasn't collected at the time of their appointment. These days, high patient responsibility is the norm and creating a partnership with the patient that allows them to fell comfortable with their payment amount, while still reducing their balance, will help to ensure either repeat customers or excellent word-of-mouth referrals.

    Careful Collection Agency

    Unfortunately, the last piece to a profitable bottom-line is a low-pressure collection agency.  Every patient has a time when paying their medical bills proves to be difficult.  But, a collection agency that understands the patient's predicament while working hard toward collecting the balance will keep the negativity out of this regrettable situation.

    In Closing

    Although revenue cycle management best practices are different on a small stage, the big picture includes all faculty participants and has revenue cycle management as an important part of the clinical environment. Don't make the mistake of thinking that all revenue is just a matter of billing out claims. It starts from the first patient phone call and requires, most of all, accurate data collection.