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.