A Physician’s Guide to Revenue Cycle Management

by | Oct 21, 2015 | Electronic Health Records, Medical Billing

picture of young team or group of doctors

Good practices are not complete without a healthy revenue cycle. However, with the amount of patients received by hospitals and healthcare practices, a system must be established. The system will record every single detail of the patient, regardless of its relevance. In addition, the system will act as a protocol for staff that ensures no details are missed as well as the completion of necessary processes. Once this system is in place, your practice will start to make progress.

While this seems like a difficult task, the benefits heavily outweigh the extra effort. Here are some points that will lead to a stable, and lucrative, practice.

Focus on details.

This may seem like arbitrary advice, however often times it is ignored. Every error made runs the risk of affecting both records and payment collection.

Keep on target.

    Often times when patients come in for one issue, many others get discussed along the way. Be sure to note why the patient initially came in and keep this in mind throughout the visit.

Be knowledgeable about insurance.

This information is extremely important to the visit. A physician must know what type of insurance the patient has, whether or not the visit is covered, and what out-of-pocket expenses could occur from the visit. The more transparent the physician is with the patient, the easier explaining insurance policies becomes.

Collect on time.

Payments that are made on time promote a healthy revenue cycle. Since they are a direct main cash inflow, any late payments can directly impact your revenue cycle. Educating patients about their insurance policies at the time of their admittance is the best way to collect timely payments. Setting up a department solely dedicated to collections will only add to collection timeliness.

Maintain low denial rates.

    Denial rates, no matter how undesirable, will occur. This happens primarily because of improper procedure coding and performing care uncovered by the patient’s network. Unfortunately, only about 30% of patients make sure they are eligible for the procedure before they are admitted. Paying closer attention to initial coding and, again, in-depth knowledge of insurance policies are the best ways to reduce denial rates.

Ensuring Proper Reimbursements.

    Since insurance companies try to pay out as little as they can, you must have a proper system established in order to receive all the money you are owed.

Collecting Co-Payments.

    The amount of money the patient will owe (as discussed in their insurance’s co-payment terms) needs to be clarified before admittance. This ensures there will be no discrepancy between the patient and the practice and co-payments can be immediately collected.

Be sure to Pre-authorize necessary treatments.

    There are cases where procedures need to be completed even if they aren’t covered by insurance. By pre-authorizing treatments, you are reducing your denial rates and ensuring more reimbursements while helping the patient.

Of course, these points are a way to guide you to a better practice. Keep in mind that every practice has its own specific needs. Many practices struggle with a variety of problems. Having difficulties along the way is natural and bound to happen. To ensure an improvement, your practice must be consistent and dedicated to change.  As long as you are paying close attention and avoiding careless mistakes, your practice will see progress.


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