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Best Practices for Your Billing & Collections Functions (Part 1)
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To maintain the best overall financial health of any medical practice, physicians and administrators must not only ensure aggressive productivity and cost management, but also keep a very close eye on the revenue cycle function. The revenue cycle is the heartbeat of the financial aspect of the practice, and thus should be treated with most urgency and care, from start to finish. In this piece, the revenue cycle will be discussed from the perspective of what many experts would consider to be best practices at each step in the revenue cycle. 

Revenue Cycle Management (RCM) can be broken down into two primary components, the ‘Front-end’ and the ‘Back-end.’ The Front-end of the revenue cycle consists of patient scheduling, registration/check-in, patient encounter and documentation, and check-out. Back-end revenue cycle includes everything else, from coding, coding verification, charge capture, rejection management, claims submission, payment posting, patient statement submission, denial management and patient collections.

Leveraging Technology: AllMeds PM

AllMeds Practice Manager (AllMeds PM) provides the advanced workflow solutions and business intelligence tools required by modern practices to achieve many of the operational goals described below. Built with cutting-edge technologies to address today’s healthcare realities, Practice Manager’s innovative and flexible architecture accommodates wide ranges of practice sizes, organizational structures and unique processes. For more information regarding AllMeds PM, go to allmeds.com/pm.

Patient Scheduling & Registration

At registration, it is very important that patients be screened to accurately capture their demographic information, authorize services in advance with payers, and notify patients of any payments of which they will be responsible prior to the services being rendered. Once scheduled, it is very important for the registration staff to ensure that eligibility has been checked (this can be accomplished via single- or batch-run eligibility, depending on the functionality of the software), and any required authorizations have been obtained and documented in the software. The authorizations should be included in the initial claim that is submitted to the payer to avoid denial or delay in payment. Additionally, the check-in staff should re-run eligibility the day of the appointment and use some form of payment estimation, either through functionality provided by the Practice Management software (PMS) or the payer’s web-portal, if available. Once eligibility has been re-checked, payment estimation performed and payment collected, the patient is set for their visit.

Physician Documentation & Coding

During the encounter, proper and adequate documentation must be captured in the medical record to ensure that auditors cannot reasonably suggest that “it didn’t happen” or that services rendered are not justified. The documentation will be used by the coding professional to ensure that the proper codes and modifiers are assigned to the services documented in the record. Depending on the set-up of the practice and how the providers operate, the coding could be the responsibility of the provider or it could be provided by a professional coder, after the fact. Either way, this process should be treated equally as important as any other portion of the revenue cycle that could potentially lead to delays in claim liquidation or denial of payment for the services provided. A best practice for this portion of the revenue cycle would be for proper coding to be documented and for all services to be signed-off, reviewed and prepared for submission on a daily basis.

Claims Submission

Once claims are submitted to the payers from the billing system (which should also occur on a daily basis), some will likely be rejected or identified as invalid for various reasons. These reasons may include claim elements that are inaccurate or missing, or other unique elements that payers require to be added or modified on each claim. It’s very important for these rejected or invalid claims to be addressed daily, as these claims have technically not yet made it into the payer’s system for review and adjudication. Ideally, the amount of these rejected or invalid claims should be minimal, and the administrator, office staff and providers should be continually updated and educated regarding the cause of these issues to minimize future occurrences.

Leveraging Helpful Services

The escalating complexity of today’s billing requirements have pushed many practices to the edge of their internal capabilities. Many legacy PMs simply don’t provide the functionality needed to keep up with the latest industry trends. And, it’s harder than ever before to find (and maintain) staff members that fully understand today’s most complex reimbursement challenges. 

AllMeds’ Revenue Cycle Management services address today’s most difficult billing challenges and relieve you of the grinding tasks that are becoming increasingly complex and less rewarding. AllMeds RCM provides a team of dedicated professionals who are highly experienced with handling the unique requirements of today’s specialty practices. Available in temporary, partial and turnkey models, AllMeds RCM services help practices across the US reduce their A/R, improve bottom-lines, and solve revenue-critical staffing concerns.

For more information regarding AllMeds PM, go to allmeds.com/rcm.

To Be Continued…

Watch for future postings that will continue this discussion of RCM Best Practices!

 

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