6 Ways To Boost Your Practice’s Revenue
The revenue cycle is the backbone of all medical entities. Without a strong revenue cycle management (RCM) team, an organization can quickly fall apart financially. Most private practices can’t survive a month without a steady flow of incoming cash. The question is, how do practices ensure that claims go out in a reasonable time and cash flow is stable?
- Identify key financial performance indicators and measure them monthly on a dashboard that has at least 12 months of this data. The most important metrics that your RCM team should have are as follows: Total A/R per physician, percentage of total accounts receivable broken down by 30, 60, 90, and 120+ days outstanding, and adjusted fee-for-service collection percentage. Tracking A/R is crucial for any practice because every day that a claim sits in A/R is a day in which the practice loses half of a percent of possible collections. The organization loses this much when you factor in overhead and the cost of continually working these claims.
- Retain an experienced coder with at least five years of experience, including billing experience. Medical billing is not a data entry position and is the last line of defense against intentional fraud and inadvertent overbilling. It is imperative that a coder reviews the documentation before claims go out. We have seen so many practices where physicians will just mark a sheet and the staff mechanically bill whatever is marked. Physicians are not billers and many, if not most, physicians lack a detailed understanding of coding concepts such as modifiers, bundling, add-on codes, and E/M level selection.
- Maintain a system of checks and balances within your RCM department. A biller/coder or A/R follow-up representative should not have access to your software’s payment posting module. Separate team members should handle payment posting so there is no conflict of interest. We have seen billers and individuals who handle A/R write off hundreds of thousands of dollars that should have never been written off. A payment poster checks and balances a biller/coder.
- Ensure solid eligibility verification. The most important person with respect to RCM is the individual that works the front desk. In most practices this is where patients’ insurance is verified and all the demographics are entered into the billing software. If this information is wrong, claims will not go out clean.
- Proactively collect copays and deductibles before the patient is seen. Many patients are on high-deductible plans with deductibles of $5,000 or more, a trend that has increased since the passage of the Affordable Care Act. This has increased the amount of money in patient A/R, and the chance of collecting this amount is small. Ensure all patients’ insurance is verified the day before the patient arrives and check their copay and deductible. Patients who have not met their deductible should be notified of how much they will be projected to pay before being treated.
- Coordinate work on A/R. So many software programs now have siloed modules that individuals work out of in handling A/R. Although this can be efficient, it can leave out a very important piece of information. When an individual completes something in a module or moves it to a follow-up status, there is no way to observe A/R trending. Most clients have five to 10 issues with the entire A/R and, if those can be identified quickly, revenue will increase. We advise all of our RCM clients to export their outstanding A/R into an Excel spreadsheet. Billers can then create a notes section and work the A/R using the spreadsheet. This information should be stored in a secure, HIPAA-compliant location so your practice administrator can review and track progress.
Finally, ensure your physicians know the team members doing your billing. Schedule team meetings with them together to review your financial report, which you can easily create in Excel. Establish a write-off process that requires the physician to sign off on a slip before money is written off for timely filing. This type of engagement between physicians and billers creates accountability and keeps physicians informed on how the practice is performing financially.