June 14, 2024 | By: Jodi Beebe, CPC, COBGC, CPMA, CPB
One physician’s group quest for revenue cycle greatness…
As payer rules and edits become increasingly strict, finding ways to improve coding accuracy and foster a corporate culture of compliance is crucial. A significant return on investment exists for maintaining an excellent revenue cycle within any size clinic.
- Reworking claims due to payer denial is, at best, a break-even proposition, and at worst, it will cost your organization more than the payment pursued.
- Payer audits (UHC pre-payment audits, for example) are difficult to avoid once Optum monitors your clinician’s documentation and billing practices.
- Government payer audits can produce alarming repayment demands and, in the worst cases, lead to exclusion from the plan.
Now is the time to give your Revenue Cycle the attention and resources it deserves to ensure a maximum revenue stream and protect your organization from payer denials and clawbacks.
Coding Education is the foundation:
Identify clinician partners who are willing to be coding champions.
Provide ongoing coding education for clinicians, coders, and clinical staff.
Engage coding consultants from outside your organization to help develop and present coding education topics relevant to your specialty.
Schedule regular audits and feedback for coders and clinicians.
Collaboration:
Identify key organizational stakeholders who will sponsor quality initiatives and support improvement projects.
Buy-in from required collaborators (IT, operations, clinical leadership) is crucial to success.
A cultural shift in organizational bias and priorities may be needed. Effective lobbying is required to allocate limited resources. Building relationships and partnerships with key departments and leaders can help overcome barriers.
All departments are important parts of the Revenue Cycle. However, this is not the typical perception of the financial aspect of some practices and business models.
Charge Capture:
Require providers to consistently use a standard billing communication for services provided at hospitals and surgical centers.
Develop reports to identify missed charges.
Embrace technology for charge communication (example Haiku app interface with Epic).
Denials Shrink:
As a result of foundational work, expect to see increased clean claims, correct coding due to robust use of edit rules and coding education, and decreased audit risk.
Return on investment should be significant and measurable with data and reports.
Confidence in the Excellence of Financial Teams/Rev Cycle:
The organization recognizes the value of a strong revenue cycle as a crucial collaborator, key to the group’s financial strength.
Professional and competent presence in the organization.
Coding and billing subject matter experts with a growth mindset.
Revenue Cycle Greatness:
Using technology available in your practice management system to full capability.
Leverage collaboration with key sponsors and stakeholders.
Positive perception as a valued department is crucial to your organization’s success.
Robust accounts receivable and compliance.
As with any great quest, the journey may feel long and difficult. Focusing on successes and continuous improvement will help overcome the inevitable barriers encountered.
Revenue cycle greatness is worth the effort!
Never, never, never give up! Winston Churchill
To Download the Revenue Cycle Greatness Pyramid, CLICK HERE
