March 13th, 2020
Categories: Tip of the Month

piggy bank and stethescope

Revenue cycle management (RCM) encompasses all the administrative and clinical functions that contribute to the identification, capture and management of patient service revenue. A periodic review of RCM basics may uncover opportunities for process improvement within your organization. Points to consider:

  • Do you have in-house support, or will you outsource RCM, billing and coding functions? If outsourced, do you receive consistent reports and feedback on your practice’s billing and coding?
  • Do your providers and support staff receive ongoing education on Evaluation and Management (E/M) and billing considerations specific to house calls?
  • Are your providers responsible for selecting their own billing codes or do you have an internal coding review?
  • Do you monitor certain services (e.g., time-based) for accuracy and completeness prior to claim submission?
  • Are progress notes locked and signed within 72 hours? Who monitors open encounter lags?
  • How quickly are claims being paid and who follows up on outstanding unpaid claims/denials?

Also, be sure not to overlook the following:

  • Credentialing – Documentation of each payer enrollment process and ensuring all providers are credentialed with each payer.
  • Office of the Inspector General (OIG) Compliance – Section 6401 of the Affordable Care Act (ACA) requires providers to develop and implement a formal health care compliance program.
  • Denial management process – Examine, resolve and/or appeal claims to recover lost revenues.

Finally, remember that, whether managed in-house or outsourced, successful RCM strategies depend on the accuracy and thoroughness of front-end tasks, such as verifying active insurance coverage prior to visits and the effective denial management process mentioned above.