What is revenue cycle management means for physician practices? The revenue cycle for a physician practice means tracking payments and revenue collection from patients. It starts with registration and scheduling of patients, proceeds to insurance verification, co-pay collection, handling health records, coding of clinical procedures performed, charge entry, claim scrubbing and submission, payment posting, denial management, A/R follow-ups, and compiling collection statements.
More than 23% of the total healthcare providers in the United States are independent practices which mostly comprised of solo physicians or a team of 2 – 5 physicians, and medical practices with 31 – 100 physicians represent 11%. These independent practices represent a major part of the medical providers and manage most of the care delivery system along with hospitals and large medical entities, treating millions of patients every year.
However, these small and medium-sized independent practices are facing financial challenges that started almost a decade ago when the HITECH act triggered technology-based reforms. These physician practices were required to adopt electronic health records (EHR) systems and many other clinical technologies that increased their budget and operational costs.
More than ever, medical practices are concerned about the collections and revenue targets, to keep the business operational. Billing and other financial processes require consistent working of dedicated resources to manage payment claims, payment follow-ups, and revenue cycle management. The revenue cycle is a combination of the front desk and back-office tasks that are linked together like a chain and even a small glitch in the workflow can disrupt the process. This is why unified processes that can bridge the communication gap between the front and back-office resources improve the revenue cycle.
Every step of a revenue cycle must be taken accurately and an optimized workflow ensures that the provider would meet its revenue targets and is critical for the financial success of a practice. Various factors influence the revenue cycle and optimizing which can increase the collections.
1. Optimized front office processes
If the front office staff fails to register patients properly then the problems start right from the scheduling. It results in missed slots and increased wait time for patients. Similarly, the inability to verify patient insurance information and wrong data entry can mess up the revenue cycle right in the beginning. The front office plays a pivotal role in optimizing the revenue cycle with optimized workflow and pristine handling the processes.
Physician practices must have an immaculate system of patient call handling and appointments, there must be a scheduling system integrated with the practice management system which can ensure steady patient check-ins.
2. Patient visits and optimal clinical flow
After the front office, the most critical phase of a revenue cycle comprises the optimized functioning of patient visits and walkthroughs in the care process. The clinical segment of the revenue cycle is where visit documents are compiled. It is where details of the patient encounter are entered; the physician enters the clinical notes and submits for further processing.
Errors and omissions at the clinical phase can negatively impact the revenue cycle. Medical billers prepare bills on the bases of clinical notes and completely depend on the information provided by a physician during a patient encounter. Missing information or mismatched medical procedures would result in the wrong preparation of medicals and would lower the chances of reimbursements.
3. Role of medical billing in revenue cycle management
The billing phase represents the most important part of a physician’s revenue cycle. Billing problems, such as, entering the wrong CPT codes which are mismatched with the diagnosis, errors in ICD codes, faults in the patient demographics and patient health information, and absence of insurance verification leads to a shattered revenue cycle. Billing is critical for successful completion of revenue cycle and the billers must be trained to code and accurately prepare bills, crosschecking and verification of the information, co-pay collection, and claim to scrub, preparing the EOB and posting payments.
However, it does not complete here and moves on to the phase where claims are submitted for reimbursements, payment follow-ups, claim denial management, account receivables, and compiling the patient statements. Optimization and management of the revenue cycle demand consistent attention of physician practices and when most of them already complain of burnout and draining of energies due to their indulgence in administrative tasks. This is why a majority of physician practices outsource the billing and revenue cycle management to teams that can help them achieve their revenue targets. RCM vendors are specialized in managing the revenue cycle of physician practices and with their knowledge and expertise make the revenue collection process smooth.