Revealed: The Secrets to a Great Revenue Cycle Strategy, Part 2


David Dyer
Vice President
RCM Group Services
& Business Development

Welcome to the 2nd installment of our 3 part series as we examine the key components to a great revenue cycle strategy. We learned in part 1 that there are no secrets to revenue cycle strategy. Instead, there are basic principles that, when properly followed either by your billing staff or your Revenue Cycle Management (RCM) services provider, will enable you to get better medical revenue cycle results.

The first three operational principles:
1. Collect patient balances the same day of service
2. Verify patient insurance eligibility
3. Implement a triple clean claims scrubbing process

The next three operational principles:
4. Remind Patients of Appointments

No-shows are a very costly component of any practice. According to the MGMA, most medical practices average a 5-7% no-show rate. While there are many strategies for managing no-shows, including no-show penalties, overbooking and collecting advance deposits for some specialties to name a few, the best strategy is a tailored and consistent automated appointment reminder program. Place someone at your practice in charge of measuring the effectiveness of automated appointment reminders based on timing and frequency. I’d also encourage you to request confirmation from your patients for appointments and track this. Population Health and Patient Portal are two effective systems utilized by our firm.

5. Tracking and Preventing Claim Denials.

Finding why your claims are getting denied, ranking them by denial code and payer, and then systematically fixing them at the source can dramatically impact both practice cash flow and operational efficiency. As is often the case, you will likely find that 20% of the denial codes account for 80% of your denials. Most claims clearinghouse solutions have this information readily available and it is just a matter of assigning the tracking and fixing of denials to a team member. Often denials result from something as simple as an incorrect referring provider number or provider linkage errors up to more complicated improper use of modifiers, etc. No matter the reason, most denials can be fixed, often by examining why they occur and fixing them at the source of your front-end processing. Clean claims rates should be in the 94-98% range.

6. Manage Insurance Underpayments

Loading fee schedules and producing a regular under/overpayment report will be very beneficial in identifying any insurance underpayments and making the necessary adjustments. Setting up access to payer websites will help you gain access to these fee schedules which can often be imported by your PM System. Also producing reports which identify any time you receive payment of 100% of a payer’s allowed amount will be helpful in identifying where your fee schedule may need a bit of tweaking.

Measuring these vital operational components and then implementing and ongoing strategy toward their optimization can pay substantial dividends in today’s challenging world of increased provider demands and shrinking reimbursement. Check back with us soon where we complete this series will a look at the final components of optimizing your revenue cycle management.