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The Revenue Cycle Process
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Overview & Recommendations


Office Contact:
  The revenue cycle process begins the day the patient contacts your office.
  • Front office staff plays a critical role in the revenue cycle process.
  • Clear concise communication with the patient is key.
  • Staff understanding of the services your practice offers and a working knowledge of how the information that they gather from the patient impacts the billing process on the back end.
  • Ensure that the demographic information you retrieve from the patient is complete and accurate. Transposing the slightest information can cause severe claims delays or claims denials. 
  • Don't miss the opportunity to collect the co-pay at the time of visit. Statistics show if you do not collect the co-pay at the time of service, you have a 50% chance of recouping that co pay later.
  • Have your office staff verbally inform the patient regarding your policy on collecting co-pays and balances up front. This reinforces any posted notifications regarding payment expectations. 
  • Have a written policy regarding co-pays for the patient to sign off on, acknowledging that they understand. 

Billing Function:  Well-versed billing and coding staff greatly impacts your revenue and A/R.
  • Documentation is necessary and precision is critical. If it is not documented, it did not happen.
  • Verify and confirm charges prior to the charge entry function.
  • If you assign the codes, then the biller/coder should do a quick review of the documentation to ensure that the correct charges have been assigned based on the documentation that supports it.
  • If there is a discrepancy with documentation, the biller/coder should review with the physician and have the guidelines handy to support any documentation shortcomings.
  • If the biller/coder is entering multiple charges, understanding the usage of ICD-9 modifiers is key.
  • Billers/coders also need to be familiar with the National Correct Coding Initiative (NCCI Edits).
  • Correct/incorrect appending of modifiers will directly affect your reimbursement.

Insurance follow up:  Do not assume that "everything will be ok".
  • Contact the insurance company within days of submission to confirm that claims were received and check on their status.
  • Do not rely on confirmation of transmittal.
  • If claims are denied, confirm the denial reason and draft a first level appeal. Depending on the denial reason, coordination between the biller/coder and the physician may be necessary.
  • Become familiar with the payors appeal process. This will ensure that you are following the proper procedures to ensure that deadlines are met.


Payment Posting: 
Knowledge is Power!
  • Familiarize yourself with your contract. Do you know how much your contract states you are reimbursed with your payors?
  • Address discrepancies quickly.  It is to your advantage for you and your staff to know what you should be paid.
  • Avoid writing off charges that the Explanation of Benefits (EOB) does not direct you to write off.
  • Audit payment postings frequently.  Catch mistakes early.


Collections: 
The patient hasn't paid.  Now what?
  • Understand when it is OK to send a patient to collections.
  • Learn the compliance requirements for sending a patient to collections. 
  • Clearly communicate your office policy regarding the collections process.
  • Insurance companies place the burden on physicians and their staffs to educate the patient as to why they have to pay non-covered expenses with their services.
  • Staff must be cognizant of their communication when working with patients on collections accounts.   

2015 H Street, Sacramento, CA 95811

(916) 822-5246

(916) 822-5247

opsc@opsc.org

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