At the end of the day, all practices are seeking the same thing: increased revenue and decreased costs. Revenue cycle management is key to staying above water, especially for small and independent medical practices. While each office has its own unique billing needs, consistency in a few key areas can significantly boost revenues while reducing rates of rejection, underpayment and the age of outstanding claims and accounts receivable.
Using this road map, offices can tailor their workflow to their specific needs, and medical software can dramatically improve the efficiencies for each provider and practice.
THE FRONT OFFICE
In the front office, three things matter most: insurance verification, co-pay collection and balance reviews. E-verification has sped up the process of checking patient insurance policies. The front office can quickly check patient eligibility using these systems, and it should be done for all incoming individuals – not just new patients or those switching insurance plans.
The front office should also make sure that its co-pay collection is handled efficiently. The key here is to make a habit of collecting co-pays up front. Practices hoping to maximize revenue cannot assume that patients will eventually pay, since the number of factors that jeopardize a co-pay statement ever being paid are so abundant. Even small co-pays should be gathered up front. The sooner the front office makes this habit, the sooner your revenue stream will stabilize.
Finally, the front office is in charge of balance reviews. Practices need to make sure that they collect patients’ outstanding balances alongside co-pays at the start of each visit if possible. Otherwise, working out a payment plan with the patient is the next best option. Luckily, the right medical billing software can pull up the balance immediately for front desk staff, allowing them to explain dollar by dollar where everything on the statement originates. This helps keep accounts receivable up to date. According to recent studies, as much as 30 percent of practice revenue can be lost by not collecting co-pay and co-insurance balances. Even the rising expenses of supplies and postage for statements can factor into losses.
THE BACK OFFICE
In the back office, there are two major areas of concern: coding and accounts receivable (AR) management.
Keeping up to date with codes can be a challenge for some practices. Medical codes are under constant revision, with new arrivals and minor or major changes occurring monthly. Joining specialty associations can help physicians stay ahead with general coding change updates: multi-disciplinary doctors may want to subscribe to multiple association newsletters online. Failing to keep abreast of coding changes could lead to rejected or underpaid claims.
Coding is especially important now because of major overhauls occurring with ICD-10 starting. Staying updated on codes and using the right medical coding software can keep rejections and underpayments at bay.
Accounts receivable is essentially money owed to a practice by patients, which is why AR management is key to improving general revenue increases. Like every other aspect of healthcare revenue cycle management, consistency is key with AR. Billing done in-house should be reviewed at least twice weekly, but medical practice software and medical billing services can also help practices stay on top of outstanding claims in an efficient and easy-to-manage way.
THE BILLING STAFF
Practices that do their billing in-house need an experienced staff to manage the revenue cycle. The most important thing a practice can offer its billing staff is continuing education. Employing workers who are knowledgeable and up-to-date on the best billing practices is a must. Practices should set aside time in the billing staff’s weekly schedule for continuing education via webinars and classes. This is especially important as major changes in healthcare approach. Getting claims paid in full the first time consumes significantly less time and money than managing endless follow-ups on rejections and underpayments. Getting the billing staff up to date on ICD-10 is equally important as that transition approaches.
For practices using medical billing services via a third-party group, communication and transparency are of the utmost importance. Ideally, a practice should always be cued into what is going on with its billing and able to access reports on demand. Any inconsistencies can be acted on immediately so long as that line of communication is open. These billing services can be an enormous boon to busy doctors, but they operate best with full transparency.