VITAL TO YOUR PRACTICE’S SUCCESS

Revenue cycle management is essential to operating all clinical and administrative data that enters the hospital and your practice. With the use of proper software assisting the process, it remains a laborious and complex procedure. In the case of hospitals, large amounts of data travel through several departments. Accuracy is critical to managing a patient’s hospital or office visit, from registration to bill payment. 

The daily maintenance of a practice’s revenue process should follow these nine steps: 

1) Pre-registration 

2) Registration 

3) Charge capture

4) Utilization review

5) Coding 

6) Claim submission

7) Remittance processing 

8) Insurance follow up 

9) Patient collections.  

As revenue cycle management expands, medical practices and facilities need to work as one unit. For goals to exceed expectations, the process must unify all departments. Data must be accurate and adequately communicated – ensuring staff knows their responsibility in adhering to revenue cycles. Therefore, practice managers must eliminate inconsistencies from everyday functions.

Pre-Registration

Pre-Registration is the collection of patient information before the visit. This collection consists of the patient’s:

Name

Address

Phone number/email address

Date of birth

Insurance information (identification number, policyholder, etc.)

Depending on the circumstances, the provider may want to know the patient’s health history. 

The entire pre-registration process should be done online at the patient’s leisure. This implementation into your front office’s workflow not only saves your practice time but it prepares the patient for the office visit. They can then address any issues before coming into the office, such as past-due balances, inactive insurance, or failed pre-authorization required for a visit.

Registration

The registration process should go smoothly if your patients complete the pre-registration sent to them the day before. Therefore, all that is left for them to do is verify all information is accurate. This information includes the financial policy of the office and the acknowledgment and assignment of benefits.

Charge Capture

Charge Capture is used by doctors and other health care providers to record services provided to patients. The practice must perform the charge capture through the use of electronic health systems. Electronic health records or EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users (CMS.gov). Once the physician signs off on the chart, it is then transmitted, reviewed, and processed for the billing process. 

Coding

Healthcare facilities should all have an external scrubbing system. After the physician enters procedures performed, they add the diagnoses and signs off on the chart for billing. However, before the claim gets sent out to the insurance company, the biller must ensure that the Evaluation and Management codes are appropriately utilized and that no expired diagnoses are attached. Taking the time to review this will prevent delays in claims processing and payment.

Remittance Processing and Insurance Follow-Up

The health care payment and remittance advice transaction is the transmission of either:

1) Payment, with information about the transfer of funds and payment processing from a health plan to a health care provider’s financial institution

   OR

2) Explanation of benefits or remittance advice from a health plan to a health care provider (CMS.gov)

Remittance processing is vital to the functionality of RCM. For instance, if the facility and insurance company has an agreement that endoscopies are reimbursed at $2000 in-network, but the remittance states otherwise, the biller should immediately escalate this to the insurance company’s representative. The biller must take the same action if procedures are unpaid or pending payment after a certain period.

Patient Collections

The front office must receive the patient’s co-pay at the time of service. If they have a deductible AND a co-pay, the front office may deduct the co-pay from the estimated amount to be applied to the office visit. There should be a standard amount expected and made available to the front desk for reference. In addition, before procedures are performed in the office/facility that the insurance will not cover, there should always be a financial responsibility waiver signed by the guarantor and collected upfront. This workflow avoids unnecessary time spent on phone calls and more time focusing on today’s patients.

ACCOUNTS RECEIVABLE MANAGEMENT – NECESSARY ACCURACY

The primary objective of having an AR and RCM is to maintain the maximum cash flow into the practice by minimizing collection periods and associated costs. Well-managed offices and facilities create uniform processes to manage accounts receivables from when a patient schedules an appointment to final payment collection. Staff is adequately trained, and patient communication is clear. 

Having a consistent, reliable accounts receivable management process will assist your practice in riding these waves of uncertainty. In addition, efficiency in this area can significantly improve your bottom line profits.

Pro Initiative Billing is here to help!

References

Centers for Medicare & Medicaid Services. “Health Care Payment and Remittance Advice and Electronic Funds Transfer.” 20 September 2020. CMS.gov. 19 October 2021.

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