Four Common Problem Areas in Revenue Cycle Management

However, even in the absence of such tools every member of the team should understand how their actions impact the practice's bottom line. In addition, staff should be measured by established metrics in productivity and performance.

4. Inconsistent forms and processes. In order to have the most profitable practice possible, efficiency is key. Every form and touchpoint throughout the cycle should be standardized. For instance capturing patient data, filing a claim, and communicating with patients should follow the same process each and every time.

There are always ways to improve consistency. It is even possible to create overriding rules about primary and secondary insurance coverage to reduce confusion on how the patient is covered, and create auto-crossover. With greater attention to denial management beforehand, it's possible to reduce denial rates. Physicians can uncover many areas for improvement that may seem basic at first glance but can make significant impact to the practice.

RCM Problem Area Checklist
In addition to outlining the above problem areas in Revenue Cycle Management, here is a simple checklist for physicians in evaluating practice operations.

Are all your patient encounters are being billed in a timely manner (or at all)?

• Are you getting paid quickly and appropriately?
• Are your co-pays actually being collected?
• Are treatments appropriately pre-authorized?
• Are you taking excessive write-offs that make your A/R look good at the expense of your income?
• Are you getting critical information about your payor performance?
• Are your payors paying in a timely fashion?
• Do you have a high denial rate?
• Is a higher percentage of patient responsibility costing you additional time and money in collection?
• Is a payor is paying more or less than your other payors for the procedures you perform?

These questions can help identify areas of improvement within the process, and allow physicians to formulate an approach to Revenue Cycle Management that will help streamline operations and increase revenue.