Take These Steps to Improve Your Physician Revenue Cycle Performance

Higher volumes, lower charges and decentralized processes make optimizing the physician revenue cycle a challenging and complex process. However, an efficient, transparent and proactive physician revenue cycle that meets the best-practice benchmarks outlined below will not only strengthen your bottom line, but it can increase provider and staff engagement.

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Physician Revenue Cycle Benchmarks

Between 34-40 days
Net A/R days
 
 
< or = 2%
Denials as a percentage of net revenue
 
 
Above 85%
Evaluation and management documentation accuracy
 
 
> 95%
Copayment as a percent of expected payment
2 days or less
From the date of service claim entry date
 
 
0%
Visits without charges

How to Optimize Your Physician Revenue Cycle

  1. Build A Model
  2. Expand your Enterprise
  3. Proactive Approach

1. Build a Model That’s Right for Your Organization

Look at your physician group’s unique needs and take those into account as you build an improved operating model.

  • Standardize processes and consolidate clinic operations
  • Evaluate outsourcing vendors
  • Reevaluate your revenue cycle to identify areas for improvement
  • Manage low-balance receivables
  • Focus on improving functions with higher return on investment (ROI) potential. To do so:
    • Use low-cost/high-value strategies to manage revenue cycle in areas with low ROI. Leverage technology such as robotic processing automation to automate work.
    • Implement targeted rebilling initiatives
    • Determine appropriate timeframes given the risk and reward of population
    • Engage vendors for targeted follow-up activities

2. Expand Your Charging and Coding Enterprise

Create a comprehensive system for charging and coding by organizing charging and coding functions into an end-to-end process with clear roles, goals and metrics to track success. This will lead to revenue realization, transparency, provider engagement, accuracy, efficiency, compliance and accountability.

Physician Documentation

  • Comprehensive documentation
  • Coder and provider education
  • Accurate coding
  • Capture charges

Charging

  • Charge reconciliation
  • Denial and write-off reporting
  • Enabling technologies
  • Automated analytics

Coding

  • Clear ownership
  • Quality audits

3. Take a Proactive Approach to Denials

A strategy for triaging and handling denials once they occur is important but preventing denials rather than trying to rectify them is more time and cost efficient.

  • Focus on root causes of denial trends rather than individual account resolutions
  • Establish a core group spanning the revenue cycle to lead denial prevention efforts
  • Create a strategy for measuring denials and ensure that data is reliable across the medical group
  • Make denials a priority from the top down
  • Implement technology solutions to enhance denial prevention

Key Takeaways

To improve your physician revenue cycle:

Think differently.

Address the unique needs of your physician group and develop a revenue cycle model that is right for your organization.

Plan differently.

Implement or improve your charging and coding enterprise to more accurately capture of charges, and receive consistent and appropriate reimbursement.

Act differently.

Proactively address denials and continue to invest in technologies that will help you become more efficient.

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