No matter how large or small a company is managing the revenue cycle is not a simple task.  Small medical offices are no different than large healthcare facilities in terms of revenue cycle phases.  The process begins from the moment the patient’s appointment is scheduled until the payments are received from the insurance companies.  Maximizing insurance reimbursements is as important to a small medical office as it is the large bed hospitals.

Financial stability in a medical office must occur in order for the business to stay afloat and operate the way it should.  An efficient revenue cycle management system can help maximize profit, save time and relieve a lot of burden from the billing staff.  The administrative costs can be kept low, and most importantly physicians and staff are better able to maintain a good rapport with patients when a proper revenue cycle management system is in place.

The Start of a Good Revenue Cycle Management System

Every revenue cycle should begin before the patient actually arrives in the office for treatment.  This means that insurance verification and other pertinent information should be gathered at the time the appointment is made.  Information such as date of birth, full name, and insurance company information should be gathered at the time of the appointment in an effort to improve the revenue cycle.  After all the more efficient the cycle, the more time and money are saved in the long run.

The beginning of the revenue cycle should also include insurance verification.  This means that immediately after scheduling the appointment, insurance verification should be made.  The best time to check verification is when the staff scheduler hangs up the phone with the patient.  Claim denials can be reduced by nearly 50% or more if the scheduler verifies insurance immediately following the appointment phone call.

During the short insurance verification process staff is able to determine further information about the patient’s co-pay responsibility, verify covered and non-covered services and obtain any prior authorizations that are needed before the patient is seen in the office.  This can eliminate problems in the future, should the patient show up for care and lack insurance verification.

Clean Coding Claims and Efficient Handling of Denials

The following stages of the revenue cycle should be handled with efficiency and include the submission of a clean claim and the prompt handling of any denials.   Clean coding claims guarantee payment the first time and prevent delays in payment processing.  This can shorten the time required to receive payment, which in turn shortens the revenue cycle process.  Clean claims adhere to the billing guidelines of both insurance companies and the federal government.

In order to prevent denials and speed up the revenue cycle management system all information must be accurate.  This means that the collection procedure of receiving patient information is critical.  Insurance companies are required to pay a claim or issue a denial in writing within 30 days of receiving the claim.  The goal of the small medical office is to get the payment in as quickly as possible by taking a proactive approach.  Having an efficient claims handling process in place is also critical.