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Come on in, the water's fine! Sticking your toe in the RCM pool

Submitted Tuesday, April 8th 2014 1:08 pm by Paul
in  keynotes  

Several years ago the American Dental Association ran a commercial that said, "Ignore your teeth and they'll go away."  A healthy revenue cycle is a lot like that. There was a time in the healthcare business when managing the revenue cycle (back then we just called it "billing") was a pretty simple process. You typed up a claim on an IBM Selectric, sent it in and waited for the check. The check, by the way was usually for about 80 percent of your commercial fee. It wasn't quite like printing your own money, but compared to billing in 2014, it was pretty close.

At The Billing Pros, our experience is that far too many physician-owners pay too little attention to their accounts receivable.  That's understandable. Between caring for sick people and meaningfully using their new EHR, providers have little time left for the revenue cycle. If you're not used to it, immersing oneself in the business side of healthcare can seem like a baptism in fire ants, and while it's natural to want to avoid that kind of thing (after all, that's why you hire companies like ours), wading in the shallow end of the A/R pool ain't all that bad, and can yield some valuable results.

 So, in no particular order, let's take a look at five steps you can take to exert more influence over the successful management of your accounts receivable.  By the way, your billing office staff will love you for this, even if it means a higher level of accountability for them.

1. Learn to read an EOB.

Trying to decipher remittance advice can feel a little like cracking secret code, but with a little self-education almost anyone can master the language and codes contained in most EOBs.  Look for a glossary at the bottom of the EOB for definitions of codes like CO-45 (charge exceeds fee schedule) and CO-252 (attachment required for adjudication).

2. Discover a new report.

Your EHR and practice management systems should have dozens of month-end and on-demand tools for analyzing clinical and financial data. Know your average days outstanding, have an accurate picture of your aging by payor class, and review production by provider, location and payor mix. God and the devil are in the details, so dig deep and ask your vendor for clarification of what the numbers mean.

3. Yell at someone.

 OK, maybe yelling is the wrong word. The point is, hold your people (or your billing company) accountable for results. People make honest mistakes from time to time and all of us deserve a little grace now and then, but never forget the majority of us do what is inspected, not what is expected.

 

4. Read your payor contracts.

The bad news here is that most of the time, your payors are reimbursing in accordance with the agreement they have with you. Very seldom do payors violate the terms of the deal. They may be heartless, immovable, self-serving and adversarial, but they usually play within the rules of the contract. The important thing here is that you need to know how your contracts compare to one another. If possible analyze your reimbursement data to compare allowed amounts per CPT across your top payors. That way, you'll at least be armed with some valuable information for the next negotiation.

 

5. Ask questions.

Your business partners and vendors spend all of their time thinking about problems you have, and imagining ways to solve them. Chances are, your "in the trenches" internal staff and business partners have some ideas worth considering. Or try this - the next conference you attend, invest your time in the exhibit hall picking some brains. You may learn more there than in the breakout sessions.

Want to find out more about revenue cycle management services from The Billing Pros?  Click Here to contact us.

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The Billing Pros - Powered by Cvikota, is also affiliated with the following medical billing companies: HealthOne and EMS Billing Pros, as well as our website development division, Webteam, Inc. The Billing Pros serves clients nation-wide, including Wisconsin, Minnesota, Iowa, Illinois, Michigan, Nevada, California, Wyoming, Arizona, Tennessee, and Kentucky.