Be Certain Staff Knows Your Revenue Cycle Management Processes

January 31, 2013

Does your staff really know what “revenue cycle management” means or is? I am constantly advocating the importance of training your entire staff to understand how their jobs functions affect cash flow. There are many points of entry into the revenue cycle at your practice. Be sure your staff knows all of the following:

  • Patient access (e.g., scheduling and registration, insurance eligibility verification, and service preauthorization)
  • Charge processing (e.g., capturing and coding serv­ices and entering data)
  • Bill processing (e.g., the production and submission of claims and patient statements)
  • Payment posting (e.g., line-item posting or payments and denials/rejections)
  • Accounts receivable (A/R) follow-up (e.g., resolution of unpaid insurance, patient-responsible charges, appeal of third-party payer rejections and denials, and collection agency performance)

Set the bar

Realizing where you generate revenue at your prac­tice is the first step to understanding the revenue cycle. The next step is to benchmark your revenue cycle management processes. To establish a bench­mark with which to compare data, report and review at least monthly information about the following 18 revenue cycle performance indicators.

Your initial review of these indicators should allow you to quickly spot areas ripe for improvement. Over time, these indicators should serve as quantifiable numbers by which you can measure improvement in your revenue cycle:

  • Percent of scheduled patients vs. available visit/ surgery/procedure appointment times
  • Percent of scheduled preregistered patients vs. total scheduled patients
  • Percent of insurance eligibility verifications vs. total scheduled patients
  • Percent of insurance pre-authorizations vs. total required for services rendered
  • Percent of point-of-service collections vs. scheduled patient-responsible balances
  • Average number of missing charges vs. services rendered
  • Average days between service date and charge entered
  • Average days between charge entry and claim submission
  • Percent of pre-submission claim errors by category for total claims processed
  • Percent of post-submission claim errors returned from carriers
  • Percent of denied/rejected claims appealed suc­cessfully vs. total denial/rejections
  • Average days between entry of patient-responsible balance and statement processed
  • Percent of undeliverable patient statements for total statements processed
  • Average days between receipt of payment and pay­ment posted
  • Number of non-contractual adjustments taken per claim remittance advice posted
  • Average number of unpaid claims resolved by day per collector
  • Average number of unpaid patient balances resolved by day per collector
  • Percent of A/R over 90 days old
  • Average days in A/R

Remember, you can’t manage what you don’t measure. By quantifying and analyzing these important indicators, you can help ensure your medical practice is not losing revenues and cash flow. Also, make sure you are constantly training your staff on the practice’s revenue cycle management processes – another efficient and effective way to avoid lost revenues.

Reed Tinsley, CPA is a Houston-based CPA, Certified Valuation Analyst, and Certified Healthcare Business Consultant. He works closely with physicians, medical groups, and other healthcare entities with managed care contracting issues, operational and financial management, strategic planning, and growth strategies. His entire practice is concentrated in the health care industry. Please visit www.rtacpa.com

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