Physician revenue cycle seems simple; however, every patient visit has at least 21 critical components that require daily monitoring to keep cash flowing:
- Pre-visit/patient calls for appointment
- Entering the patient in the EMR
- Check-in
- Visit documentation
- Potential charges recorded on super bill
- Visit coded
- Check out and co-pay collection
- Posting the charge
- Preparing the day’s batch and checking for missing tickets, hospital reports, etc.
- Verification of the charge and information by the billing office
- Scrubbing the bill
- Transmitting the bill electronically or by paper
- Preparing the documentation, if necessary
- Preparing the EOB for appropriate posting of the payment
- Preparing the check for deposit
- Posting the payment to the correct patient
- Reviewing and preparing any denials
- Getting the additional information for denials from the office
- Resubmitting the claim
- Working the aged accounts receivable
- Sending the patient statements
Here are a few examples of what can go wrong when the patient calls for an appointment:
- Staff records the wrong insurance
- Staff fails to collect an insurance information
- Staff makes the appointment for a patient who has insurance that is not under contract
Or when the bill is prepared:
- Forwarded to the wrong insurance company
- Wrong CPT code
- Diagnosis code doesn’t match CPT code
- Patient information is incorrect for the type of service performed (e.g. a female procedure performed on a male; an adult procedure performed on a child)
- Place of service doesn’t match type of service
With insurance companies looking for any opportunity to deny or delay a claim, it’s not unusual for up to 10 percent of claims to be denied and require rebilling. That alone can increase a physician’s overhead by $5,600 a year.
HSG suggests performing a revenue cycle audit every three years to tune-up all 21 points of the revenue cycle.