October
1, 2007
 Achieving
Optimal Revenue in a Physician Practice
By Komal Choudhry
For The Record
Vol. 19 No. 20 P. 14
There’s not one standard method to improve revenue
cycle management, and it’s not something healthcare organizations
can do once and not think about again. It is a constant effort geared
toward improvement. With that in mind, here are several areas to focus
on so cash flow remains swift and current.
Patient Balances
The goal is to minimize these balances and maximize patient collections.
Patient balances can quickly add up and, over time, become more difficult
to collect. As soon as a balance is due, staff should try to collect
it. The first bill should be sent out immediately, and the front desk
should have access to patient balances so it can issue patient reminders.
Patient bills should be mailed regularly, and decisions for which balances
to send to collections should be made on a consistent basis. A practice
should take a firm but fair approach to maximize collecting patient
balances. Don’t be afraid to ask patients to pay—you have
every right to collect a payment.
Include More Services
Be careful that the equipment is not pricier than the actual reimbursement.
A simple analysis can be done by multiplying the reimbursement by the
number of patients who will receive the service. Don’t rely solely
on the vendor’s reimbursement numbers; be sure to check the reimbursement
figures of several insurance plans as well.
Reimbursement also depends on the practice’s specialty.
At the same time, adding tests can truly add to the bottom line. Also,
be sure you understand how to code for the procedure to ensure proper
payment and the shortest payment cycle.
Submit Claims on Time
This sounds simple, maybe even logical. Still, are your claims being
submitted on a regular basis, or are some held back because of missing
or incorrect information? Ensuring you have everything, from correct
patient demographics and insurance information (including services performed
outside the office) to referring physician information, will enable
all claims to be regularly submitted and revenue to come in steadily.
Proper Documentation
Depending on your specialty and the claim specifics, the insurance company
may request to see the documentation. Have documentation typed at the
time of the encounter so that it’s available to submit immediately.
Not doing so will cause a delay of at least two days.
Follow up With Insurance Plans
Behind submitting clean claims, this is the second most
important billing task. If follow-up is ignored, healthcare organizations
won’t know the status of unpaid claims. Also, make sure phone
calls are being made to determine the status of denials and unacknowledged
claims. It’s time-consuming, but it’s necessary to ensure
that the organization is maximizing its revenue.
Equipment Consolidation
Think about the equipment in your office. For example, do you have five
different brands of fax machines? That means five different toners and
understanding how five different machines operate. Are you even using
all of them? Consolidating and streamlining by using the same fax machine
manufacturer will help save money. The same goes for printers and copiers.
In-house billing
How much time are billers spending on data entry? Could an investment
in technology allow them to spend more time following up on claims and
collecting patient balances? Whether you need to improve workflow or
implement a practice management system, cutting data entry time is a
must.
By writing neatly, physicians will eliminate the need
for billers to question their diagnosis codes. This saves time and possible
lost revenue if the diagnosis in question is never clarified. Outsourcing
billing can help free staff to perform other tasks related to patients
and the practice while still being cost-effective.
Are You Billing for All
Services?
Many providers are not billing for services they perform and in some
cases are losing tens of thousands of dollars per year. If you are a
surgeon, do you have a certified coder reviewing your operative notes
and making certain you are billing optimally? Or have you been billing
for the same procedures for the past 10 years?
You also may be billing incorrectly. Have someone occasionally
review your coding to make sure you are coding all you can and are up-to-date
with code changes. Maintain knowledge about codes, coding, and medical
necessity instead of relying completely on your billers. Doing so creates
a smoother flow in billing.
Education
Make sure staff is knowledgeable about insurance issues and the basics
that influence billing. The front desk should be able to understand
how to read insurance cards—at minimum—and accurately enter
patient information. Checking insurance eligibility, which can help
prevent denials, has become easier thanks to the Internet and better
customer service from insurance plans.
There are several factors that influence an organization’s
revenue cycle. To see an improvement and a steady flow of income, permanent
changes must be monitored on a regular basis. Inherently simple measures
can yield great results. Providers have to work at it on a daily basis,
but nothing short of that will get you the desired results—an
improved revenue cycle.
— Komal Choudhry is an executive for DocComply,
a company that provides an integrated electronic medical record/practice
management solution to physicians, and a freelance medical writer.
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