The healthcare revenue cycle is complex and interconnected. A few flawed processes can weaken the entire reimbursement chain and lead to poor financial results. Fortunately, this also represents an opportunity.
Optimizing business office processes, payer relationships, patient flow and information system configuration can bring about exceptional gains in both cash flow and net revenue. This is especially important as organizational structures, reporting requirements, and reimbursement methods are changing to accommodate the new realities of the healthcare system.
Asking the following questions can help healthcare leaders evaluate the revenue cycle strengths and weaknesses of employed physician practices.
- Does the practice verify insurance info (using batch eligibility) prior to appointments?
- Are the patients informed of payment expectations prior to arrival for their appointment?
- Is the staff trained to collect co-pays, deductibles and past-due balances at check-in?
- Does the practice have a written financial policy that is provided to all patients?
- Does the practice verify coverage for specific services?
- Does the practice update procedure and diagnosis codes annually, as well as perform a coding audit?
Charge Capture/Claim Submission
- Does the practice capture 100% of office and hospital charges?
- What is the lag time from date of service to date of claim submission?
- Are claims submitted daily?
- Does the practice use electronic funds transfers (EFTs) and electronic remittance advices (ERAs)?
- Does the practice load payer allowables and track payment variances?
- Does the practice track denials?
- Does the practice monitor write-offs and have an appeals process?
Accounts Receivable Follow-up
- Does the practice follow up on all outstanding balances: payer and patient?
- Does the practice have a dashboard report that is reviewed monthly and compared to industry standards?
This Health Directions presentation discusses the use of key performance indicators to improve the revenue cycle in hospital owned physician practices.
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