Here’s a cheat sheet covering steps your practice can take in order to optimize the entire revenue cycle management process and lead to a healthier bottom line:
Coding: Any practice’s reimbursement process begins with coding.
___Take pains to be sure that all coding is correct.
___Be up-to-date on coding practices – especially with the upcoming change to ICD-10.
___Have all studies read by a certified coder in order to catch potential mistakes.
Claims:
___Submit claims in a timely manner.
___Be sure the claims are clean – have been scrubbed – and complete.
Quality of Work:
___Assure accurate encounter documentation.
___Periodically review coding to assure correctness – highest level of reimbursement appropriate to the level of care provided.
___Perform regular audits, including random claim samples.
___Encourage strong communication throughout the organization to clear up any confusion or concerns promptly.
Efficiency:
___Periodically review the claims submission process with an eye to improving efficiency.
___Invite a trusted colleague to review the process to look for ways to streamline it.
___Promote a culture of openness so that staff feel comfortable suggesting improvements.
Manage Accounts Receivable:
___Create an effective accounts receivable team for management and collection of outstanding balances.
___Oversee this accounts receivable team to ensure that nothing falls through the cracks.
___Implement proper claims denial measures and periodically review their use.
___Create a reporting structure to keep updated on all Accounts Receivable issues
Collections Team:
___Create a team to review and collect unpaid balances from patients as well as unpaid claims.
___Create a list of patients with unpaid balances for the receptionist to refer to when scheduling appointments. The receptionist can then ask the patient if they need help in satisfying their obligation.
___Pursue smaller balances as ardently as the larger balances.
___Utilize software systems which alert the team to pertinent information regarding outstanding balances.
There must be an aggressive management, tracking and reporting structure in place. It is key that best practices are adhered to in every stage of the revenue cycle process. When this is the case, increased efficiency and profitability will follow.
