By Steven Bisciello, partner and Bri Clarin, manager, EisnerAmper

For healthcare organizations both large and small, employing a revenue cycle approach that is sensible and successful is critical to profitability. The revenue cycle is comprised of three main “offices” or areas: front office, middle office and back office. All three areas are linked, and are dependent on one another to function in order for the organization to bill and collect timely and accurately for its services. Poor strategy, missing or inaccurate processes, technology issues and/or personnel challenges affect all of the three areas and can lead to suboptimal revenue cycle performance.

As the new year is upon us, it’s the perfect time for healthcare organizations to understand their current performance and processes and compare those to best practices. This can easily be completed via a revenue cycle assessment. The assessment will identify both one-time and ongoing improvement opportunities and what their worth is to your bottom line, and ultimately maximize your profitability for the next year and years to come. Just as important, a thorough revenue cycle assessment typically delivers a solid return on investment.

As part of that assessment, revenue cycle managers should ask themselves the following questions:

Is your front office being optimized (e.g. to ensure insurance verification, that eligibility is happening on a routine, proactive basis, etc.)?
Knowing your patients’ benefits is crucial to identifying first which payers should be billed and then your patients’ financial responsibility. Timely and accurate identification allows for timely and accurate provider slot booking, financial transparency with the patient and ultimately accurate first-pass billing. The training of your team on this knowledge is just as important as the explanation to your patients.

Is your “time of service” collection process efficient enough?
The revenue cycle begins at the request for a patient visit. With many high deductible plans, a lot of payments will be coming from the patients directly, especially in the first two months of a new calendar year. Achieving “pre-registration,” which includes collection efforts, both pre-visit and at the time of visit, has a positive trickle-down effect. This includes reduction in back-office/outside vendor collections involvement, overhead reduction in sending multiple statements, and cuts back on business office calls.

Do you have a system in place to monitor denials and accounts receivable?
Denial management is crucial to both your current and future receivables. Timely identification, follow-up and information sharing “upstream” provides all revenue cycle office areas and providers valuable insights. This includes insight on preventable issues as well as technology needs or tweaks to existing technology set up, such as billing system edits, coding education and training. You should always be able to identify and track your organization’s recurring denials, overall denial rate and denial overturn rate. This will help practice leaders dig in and implement changes where necessary in real-time, including registration retraining, prior authorization process and others.

Are you getting paid timely and accurately according to your contracted rates?
For accounts receivable, consistent monitoring of items such as liquidation time by age bucket and by payer (versus adjudication time) and collections by age bucket, helps you understand where your payments are coming from (i.e. clean claims versus worked/aged claims). This sheds insight into your collections performance and assists in avoiding untimely filing denials and bad debt write-offs.

How EisnerAmper can help
EisnerAmper’s Health Care Group assists organizations by performing deep-dives into clients’ revenue cycle performance, utilizing proven modeling, identifying opportunities for improvement and creating a customized plan for overall implementation and increasing profit. Click here to learn more.