Vanessa Moldovan and Sherrie Anderson | Region 5 – Southwest

With complex payment models growing, and higher out-of-pocket patient responsibility, zoning in on key functions to improve revenue efficiency is crucial to a practice. There are many puzzle pieces to fit together within a patient visit to achieve revenue efficiency. Revenue begins with the patient scheduling the appointment and ends when payment is received from the payer.

Scheduling: Obtaining correct insurance information and demographics is a critical step in billing the payer. Incorrect plan and/or demographics will result in a denial. Delayed payment is lost revenue.

Pre-Arrival/Pre-certification: Does the practice have a pre-arrival/pre-certification team? Obtaining referrals and pre-certification prior to the visit is an imperative effort for ensuring payment receipt.

Documentation: Did the provider document correctly and timely? Documentation should be clear, supportive, and timely for billing and payment.

Coding/Billing: Was the charge captured and billed timely? Is the coding accurate and correct? Correct billing is also crucial in your effort to receive payment.

Denials Management: Is there a denials team working rejections timely and accurately? When a charge is denied, that first appeal or reconsideration needs to pack a punch in efforts to turn loss into gain. Each attempt to work through an appeal process for a charge, costs time and money. Immediate denial action is another critical step to recoup payment, which will help ensure the livelihood of your practice’s revenue cycle.

Healthcare is ever changing and evolving. Revenue cycle efficiency has become more challenging. Providers and practices must have team support in all areas to foster a successful revenue cycle.

Southwest Region 5