Optimize

Revenue Cycle
Management
What is Revenue Cycle Management?
• In a nutshell, it means taking steps to assure that you get paid for what you do and that
you get paid in a timely fashion.

• The revenue cycle starts when the patient calls your office for an appointment and your
staff captures the patient’s name, phone number, and maybe the name of their
insurance company.

• The cycle ends when the balance on their account is zero.

Four steps to effective revenue cycle management:

• Gather Data • Use the Correct Numbers

• Verify Eligibility • Automate the Process as Much

as Possible
GATHERING DATA
• Some practices say they can’t afford to take the time on the phone when the patient
calls for an appointment to collect insurance information. That means that the
practice doesn’t get to verify the patient’s insurance coverage before the
appointment.

• If you don’t verify coverage before the patient presents, you have to hold up rooming
the patient to verify the insurance when they check in. That’s inefficient for everyone
in the practice and often puts the whole schedule behind for the day.

• Pre-visit eligibility verification is a best practice that every physician office should
strive to accomplish. If you find out that the patient is not covered for the visit a
couple of days before the scheduled appointment, you can contact the patient to
either get corrected information, or maybe even reschedule the patient if necessary.
 • You can submit all patients on a day’s schedule in an electronic file and send it to a
clearing house to verify eligibility for all appointed services (it’s called “batching”).
Doing so will reduce the volume of denied claims.

VARIFY ELIGIBILITY
• During a recent consulting engagement, a sampling of denials showed that 3,450 claims
had been denied the first time they’d been sent through. That’s a first-pass denial rate of
6.9%; the rate for better-performing practices is approximately 3%.

• Approximately two-thirds of the denials (2,270) were because of eligibility issues.

• The cost of managing those denials is approximately $25 per claim, which means that
that group spends $18,900 every month to work denials that could be eliminated with an
investment in batch eligibility for all scheduled appointments.

• It takes four individuals in the billing office to work the denied claims for that practice.
USE THE CORRECT NUMBERS
•Accurate patient registration and billing information is a critical first step. Getting the charge
posted with the CPT Service code and ICD-9 diagnosis code on a timely basis is the next step
in the revenue cycle process.
•Some practices hold their charge slips for a full day or even more. Sometimes they have
someone cross referencing the appointment schedule against all the charge slips to be sure
they have not missed charges, but that delays the charge posting and billing process by at
least a day.
•Most practice management systems have a “missing charge” report that automates the
cross-check process so there is no added value for holding onto charge slips for a day; and, in
fact, the process of holding charges increases the work load by forcing you to check each
charge slip against the report, rather than simply hunting up the missed charge slips as
identified by the report.
•If you’re not using the missing charge report function, find out why not and consider using it.
If your practice management system doesn’t have the function, ask if it can be added, or do
a cost-benefit analysis on switching systems.
AUTOMATE
MORE
• The revenue cycle process is enhanced with electronic claim submission and
electronic remittance payment posting.
• Automated posting saves staff time and that time can be used to follow up on
outstanding claims or overdue balances.
• The quickest way to a zero balance is to automate those tasks that do not require
your billing staff’s expertise and to use that expertise to communicate with the payers
as needed.
• You can also shorten the revenue cycle by offering your patients online bill payment
and e-statements.
• E-statements cost less than 60% of the price of a paper bill to produce.
• You pay your own bills online, why not invite your patients to do the same for your
practice
 MDOffice Manager Contact Details :

www.mdofficemanager.com
MDOManager

info@mdofficemanager.com
MDOfficemanager

812-248-9206 MDOfficemanager

1410 S Clark Blvd, Suite# 2100, Clarksville,IN 47129

Thank you!