Among my duties is making sure our practice gets paid for professional services. Please understand, I am not saying for a minute that this is a one-person deal. In fact, it’s far from it. You will quickly see as I touch on the three major components of the revenue cycle that it takes a “village” to be sure we get paid. Many people, from those who work at the front desk to those who post payments, are involved. Actually, I could go further both upstream and downstream and name even more positions that play a key role. But, let’s keep it simple.

Before the discussion, let’s take a moment to give credit to our great physicians for the work they do. They are the reason we get paid. We should never forget that fact. In that aforementioned spirit of simplicity, let’s now talk about the revenue cycle. It can be broken down into three major components.

1. Appointments and Capturing Patient Demographics
Ideally, we would have an error-free front desk. We know that humans (all of us) make errors, but these should be minimized. Front-desk work is complex, and we try to supply the fine people who work there with all the tools they need to do the job and that is largely in the form of Centricity, our patient accounting software system. It supports the collection of patient demographic data and insurance information as well as scheduling. We want to assure that all patient appointments are managed and no charges lost. Centricity includes electronic insurance eligibility, which is very important and, when done improperly, a major reason for claims denial.

2. Capturing Charges and Submitting Claims
Charge capture from Cerner, our electronic health record (EHR), reduces manual charge input. We want to minimize denials upon submission and that is why we use a “claims scrubber” to try to get them right the first time. We file most claims electronically. One of our key metrics is comparing what we expect to collect to what we actually collect. The goal is to be paid 100 percent of what we are owed based on the particular payer contract.

3. Remittance Posting, Collections and Data Analysis
Finally, we use electronic remittance whenever possible and post the full adjudication amount approved. This includes what is paid, any deductible, any co-insurance and co-payment as well as all denials. Before we post payments, we have to make sure the money is in the bank. This is critical. Next, it is important for us to manage denied claims aggressively. It is also important to understand new rules that payers put in effect that may delay our receiving payments. We look for trends. We handle write-offs, adjustments and refunds. Finally, there is the data analysis work.

That is enough for today. However, I do appreciate the help of all to make this complex work go smoothly.