Pick up any medical practice management publication and there are a ton of references to Revenue Cycle Management. This is the buzz phrase in any physicians office or medical billing department. So what does it really mean
Simply put, revenue cycle management is getting your dollars in the door. One of the best ways to make sure you do just that is by implementing a comprehensive front end process. Dont let this get confused with clean claims and claim scrubbing. We all know that if all you had to do was send in a clean claim and we would be guaranteed payment all accounts receivable personnel would be out of a job. A comprehensive frond end process starts at the time you schedule an appointment and includes:
1. Obtaining accurate patient insurance information including patient ID
2.Verifying patient eligibility for the date of service
3.Assessing the need for a referral or authorization for the visit
4.Obtaining any needed referral or authorization for the visit
5.Determining the co-pay or deductible cost for the visit
6.Collecting the co-pay and/or deductible for the visit
While you might think that these processes are already being performed in your office you would be surprised to know how much falls through the cracks when you dont have a dedicated billing specialist that is performing a daily review and providing both your practice manager and front office staff with a comprehensive report.
Lets look at a very basic example:
You see 25 patients a day for 250 days in the year; 35% of your patients have a co-pay associated with their visit and the average co-pay is $35. That comes to $76,562.50. Now consider if you are adding labs, procedures or even diagnostic imaging. This number easily triples or even quadruples. Now add exams that were not authorized; maybe because you had no idea it even required an authorization.
You cant afford to ignore the front end process of getting patients into the practice. And while it is great to believe that automated systems and clearinghouses can give you a quick answer this will only solve a small portion of the problems. For anything other than a very basic office visit, an online verification or verification by the clearinghouse is not enough.
Revenue cycle management starts the minute your patient is scheduled. Planning ahead is one of the best ways to get your dollars in the door.
Simply put, revenue cycle management is getting your dollars in the door. One of the best ways to make sure you do just that is by implementing a comprehensive front end process. Dont let this get confused with clean claims and claim scrubbing. We all know that if all you had to do was send in a clean claim and we would be guaranteed payment all accounts receivable personnel would be out of a job. A comprehensive frond end process starts at the time you schedule an appointment and includes:
1. Obtaining accurate patient insurance information including patient ID
2.Verifying patient eligibility for the date of service
3.Assessing the need for a referral or authorization for the visit
4.Obtaining any needed referral or authorization for the visit
5.Determining the co-pay or deductible cost for the visit
6.Collecting the co-pay and/or deductible for the visit
While you might think that these processes are already being performed in your office you would be surprised to know how much falls through the cracks when you dont have a dedicated billing specialist that is performing a daily review and providing both your practice manager and front office staff with a comprehensive report.
Lets look at a very basic example:
You see 25 patients a day for 250 days in the year; 35% of your patients have a co-pay associated with their visit and the average co-pay is $35. That comes to $76,562.50. Now consider if you are adding labs, procedures or even diagnostic imaging. This number easily triples or even quadruples. Now add exams that were not authorized; maybe because you had no idea it even required an authorization.
You cant afford to ignore the front end process of getting patients into the practice. And while it is great to believe that automated systems and clearinghouses can give you a quick answer this will only solve a small portion of the problems. For anything other than a very basic office visit, an online verification or verification by the clearinghouse is not enough.
Revenue cycle management starts the minute your patient is scheduled. Planning ahead is one of the best ways to get your dollars in the door.
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