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Follow the Revenue Stream to Maximize Reimbursement

The Doctor's Office, January 29, 2009

Providers, practice administrators, and office staff members should be well versed in the basic components of the revenue stream to maximize revenue while staying within compliance guidelines.

To keep a close watch on revenue, practices must take the following steps:

Review unbilled charges daily. Failure to send claims out on time may result in lost revenue and a sluggish cash flow. However, it's not uncommon for a billing department or service to delay billing while awaiting completion of the following:

  • Insurance verification
  • Operative report
  • Clarification of CPT or ICD-9 codes
  • Missing CPT or ICD-9 codes
  • Missing modifiers

Capture all services rendered. Encounter forms, paper and EMR-based, should be updated at least annually. The most efficient way to accomplish this task is for billing personnel to meet with providers and take these steps to verify that all services rendered are captured through appropriate codes:

  • Add new CPT and ICD-9 codes that are relevant to the practice
  • Remove deleted CPT and ICD-9 codes
  • Verify that all modifiers used by the providers are on the form, including those pertinent to new services
  • Verify that codes for all new and existing services are included

Revise fee schedule annually. Most third-party payers issue a new fee schedule annually. Therefore, practices should check their fee schedules to make sure they bill above the allowed amount of the highest third-party payer billed. Staff members must also ensure that charges are paid correctly according to the fee schedule.

Keep your eye on the denials. One of the best ways to maximize revenue is to have claims paid the first time they are submitted. Once a claim is denied and has to be corrected and rebilled, the practice is not only paying office staff for this extra work, but the cash flow is slowed down.


Editor's note: Ruth Dolby is president of Dolby Healthcare Consultants, LLC, in Stoughton, MA. Contact her at 781/341-9459 or by e-mail at ruthdolby@aol.com. This article was adapted from one that originally appeared in the January 2009 issue of The Doctor's Office, a HealthLeaders Media publication.