The goal of every health care provider is to reap the benefits of their hard work by using an effective program of revenue cycle management. The necessary steps to take, in order to achieve that goal, is to collect the necessary data, verify or confirm the patient eligibility for the claim, use the right billing codes and try to automate your billing as much as possible.  The steps are clear, but they have to be followed in order to achieve a zero balance at the end of each day.

The first step is very important because revenue cycle management starts with the patient calling your office for an appointment. Your staff has to make the time to take the insurance company and other valuable billing information over the phone during the initial call.  You may consider letting your patient know that someone will be calling them back before the appointment to confirm the insurance.

If your patient’s insurance eligibility can be provided before their appointment, then your staff will not have to hold up on rooming the patient until the claim is verified.  Imagine the loss of time and inconvenience to all, when compared to the time it would have taken to get the information on the first opportunity.  If your staff is not able to get eligibility approval before the appointment, then the patient can be contacted to either provide the correct details, or at worst, the staff can reschedule the appointment until a later date.

A major disturbance in the revenue cycle often occurs when claims are denied.  The first pass denial rate for the better run practices is considered to be around 3%.  Unfortunately, the high end of that rate goes to almost 7%, and two-thirds of the denials are usually due to eligibility problems. The cost to manage the denied claims becomes a heavy expense over the course of a year; an avoidable cost in many cases.

The solution for preventing those high costs is to invest in a “batching” service run by a clearing house.  Simply, an electronic file containing the patient information for the people scheduled for a certain day can be sent out for approval in one batch.  Having the eligible versus the non-eligible sorted out for you in a timely and efficient manner is well worth the investment.

The next process in the revenue cycle is to arrange for the revenue through the use of timely billing with correct ICD-9 (soon to be ICD-10) diagnosis codes as well as the proper CPT codes.  Missing charges can really slow things down, and therefore you should consider using a practice management system that will give a report that identifies the missing charges.  Delays are minimized by a quick cross-check using the report, rather than time lost searching for the charge slips manually.

Finally, you can use IT solutions by Dell, Somega, or Emdeon to automate your office as much as possible.  You can try to get your patients to use online billing programs and to use electronic statements.  Some patients may like things the old-fashioned way, but many may appreciate the paperless route.  Your office can use electronic claim submission as well as electronic remittance posting to keep everything running paper-free as possible.  The money you save by updating your billing office and organizing it along these four steps will certainly help win you a revenue cycle management golden ticket.