Missing Links of Revenue Cycle Management

In our work with clients in search of a more profitable bottom line, we are frequently asked to identify those hidden elements of the revenue cycle that impact financial performance. The pursuit is for those factors that may not be obvious in a cursory analysis of standard revenue cycle benchmarks and performance metrics. Any process or workflow that impacts revenue calls for regular review and refinement. Identifying the missing links in your revenue cycle is the key to initiating necessary changes to move the needle to the next level of financial performance.

Several key components of the revenue cycle to examine more closely include:

• Mechanics of the billing system
• Provider recruiting and onboarding
• Front-desk processes

Mechanics of Your Billing System

‍Understanding the complexities and infrastructure of your billing system or the system your third-party billing company is using is imperative to optimizing revenue. Expecting different results from a flawed system that has been perpetuated based on initial implementation standards without doing a regular assessment and rework is a recipe for disaster. Additionally, it is incumbent on your practice management system vendor and billing resources to identify missed opportunities that may be making you less efficient or less profitable. Comparisons to other like-sized organizations may offer some insight into additional adjustments and enhancements that are necessary. Relying on standard reports provided from your practice management system or provided by your outsourced billing company can be misleading unless you understand how to dissect the mechanics of the billing system. These activities include setup and the origin of the data elements and the calculation process used to develop the reported results. This setup plays out in all segments of the revenue cycle, from payer enrollment to the front desk to working claim rejections and denials.

Provider Recruiting and Onboarding

‍If there is a disconnect between your recruiting efforts and the credentialing/onboarding processes, we will provide professional services at no charge. Understanding the timelines required for licensure and payer enrollment must occur from the C-suite to the practice to the billing department. It’s easy to tell an available (and sought-after) provider they can start in a month. Still, if there is no consideration for the lead time required to be licensed in your state, to apply for DEA and to submit/upload credentials info, services will be denied because the provider is non-participating. This also results in poor patient satisfaction as those claims are processed out-of-network. Reviewing and quantifying these denials for everyone involved helps paint a clear picture of where adjustments are indicated.

Front Desk Processes

‍The front-desk staff holds the key to capitalizing on a face-to-face patient encounter. A lack of knowledge about insurance network participation and increased errors in registration as well as inappropriate co-pay/co-insurance collection results in higher accounts receivable but also unnecessary credit balances. Reviewing the source of these front-desk errors typically points to the need for additional training. Keep in mind, uncontrolled credit balances usually impact total accounts receivable, so it’s essential to report these numbers separately to understand what is collectible.Identifying the missing links in managing the revenue cycle requires skill and diligence and a watchdog approach to protecting the success of any organization. Sometimes a fresh set of eyes can more easily identify established internal processes that may have worked in past years. However, they may now reside outside the perimeter of industry standards and accepted practice revenue metrics.

If you’d like to learn more about interim leadership options or how our Physician Services team can support your EPN, please contact Coker Group today.