5 Revenue Cycle Focus Areas for Medical Offices

Enhance Your Reimbursements and Collections

Your medical office has opportunities at each phase of the revenue cycle to improve insurance reimbursements and collections. You can enhance the financial stability of your healthcare organization by establishing processes and practices at each step of the revenue cycle.

1

Health care reimbursement
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The revenue cycle should begin prior to the patient’s arrival. As soon as the appointment is made, the patient’s insurance information needs to be verified. Because insurance information can change at any time, even for regular patients, it is important that the provider verifies the member’s eligibility each and every time services are provided. There are many benefits to obtaining insurance verification prior to the patient's arrival.

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2

Insurance Payments
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The fastest way to increase cash flow and improve collection rates is to collect patient responsibility up front. Patients are less inclined to pay or are difficult to reach once the services have been performed. Rather than waiting until the collections stage of the revenue cycle, providers should take advantage of discussing financial issues and collecting patient payments early in the process.

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3

Receptionist on the phone
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There are lots of things your medical office can do to prevent delays in claim processing and in some instances result in a higher reimbursement. Claims follow up leads to consistent outcomes in your efforts to collect revenue. Getting your medical claims out of the door and paid as soon as possible is every health care provider's primary goal as far as finance is concerned. The faster the claim goes out, the faster the money comes in. Make sure your office is equipped with the necessary software to save time and money.

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4

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Most insurance carriers are required to pay the claim or provide a denial in writing within 30 days of receipt. A claim that has not processed within 30 days is subject to interest penalties, however, being paid interest is not in your goal. Your goal is to get payment as quickly as possible. Taking a proactive approach to handling denials can improve AR days substantially.

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5

Payment posting
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Payment posting involves posting and deposit functions and reconciling posting activities with deposits. Although it seems simple enough, this is an extremely fundamental feature of the revenue cycle. The payment posting process affects many other functions of the medical office and can have a major impact on patient satisfaction, efficiency, and overall financial performance.

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6
Collection Mistakes Your Medical Practice Should Avoid

Verifying
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To look at it from the opposite view, these are the mistakes you might make at each step of the revenue cycle that can lead to losing revenue.

  • No claim follow up. Many practices fail to follow up on claims once they've been billed. It's only when their A/R is over a million dollars and claims are two years old which is too late to do anything about it, then they ask "what happened".
  • Little or no insurance verification. Insurance can change or be terminated at any time. It is important to verify insurance benefits every visit.
  • Failure to manage denials. Keeping track of denials are a great way to find trends that can help prevent them in the future. There may be a coding issue that is not caught for months but keeping track of them can help to identify and correct an ongoing issue.
  • Not monitoring patient accounts. Practices need to be aggressive with patient accounts. Some patients rack up hundreds or thousands of dollars and continue coming in for visits without being asked to pay past balances.
  • No hesitation to write off charges. Some practices do not hesitate in writing off charges. Sometimes claims can be corrected and rebilled or appealed. Knowing payer guidelines would also limit the amount of charges written off.

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