The AMA’s updated CPT codes are now effective for 2023. Encompassing 393 editorial changes, 225 new codes, 75 deleted codes, and 93 revised codes, the changes strive to reduce administrative tasks and subsequently...
Where’s the Money! It is easy for the practice to believe that the billing company is completely responsible for all things related to their revenue. It is just as easy for the billing company to point fingers at the practice staff when the revenue lags. Both positions are reactive in nature and can undermine the financial success of the practice and the billing company.
Three quick changes in reporting will allow the two sides to work more cohesively and communicate in ways that improve the bottom line.
Key Performance Indicators
It is important to share information in ways that lead to an improved process. The billing team may frequently refer to the number of lag days without sharing the details necessary to change behavior. The software can report the span between the date of service and the date the note is signed. This is a key step in the RCM process. Notes that are signed ‘late’ delay reimbursement. The software should then report the span between the date the note is signed and the date the initial claim is sent to the primary payor. This data will highlight any delays in the coding or claim editing processes and impact the RCM process. Following the days from claim submission to receipt of payment to transfer to either the secondary plan or patient responsibility will shed light on any additional opportunities for improvement.
Likewise, when the billing team shares the standard A/R report, the total amount of revenue stuck in a bucket labeled “over 120 days” only increases frustration and finger pointing. Share the same information in a way that may prevent the dollars from ever being in that bucket. For example, group the outstanding revenue by denial code. Seeing that 60% of the revenue stuck in a specific bucket is due to an invalid NDC number empowers the practice to change a process long before the charges were sent to billing. Knowing that 25% of the denials are related to lack of subscriber id can help enforce the need to run eligibility before the patient is checked in.
It isn’t enough to have the sign at the front desk “Copayment due at the time of service.” It is important to provide the staff with the resources necessary to be confident they are collecting the correct amount. When the eligibility is checked, the copayment can be verified but the key step is to run a daily report to confirm the number of appointments where the copayment was collected, and the eligibility confirmed. Share the results in a way that will impact behavior in a positive direction.
Each EHR will have predetermined required fields within the patient demographic screen and/or the insurance fields. Additional fields may be critical to the success of both the patient experience and the RCM process. For example, collecting an email address may not be required by the system, but is mandatory if the patient portal will be used to facilitate both payment collection and sharing clinical information with the patient. The referral source may seem only important to a specialty practice, but even the pediatrician will benefit from knowing the source of their patients.
Keep the patient engaged
A standard component of any progress note is the plan. Many indicate the patient should return in 3 months, or 6 weeks, or as needed. Practices should take a lesson from the local imaging center and consider sending reminders to the patients when it is time for their 3-month follow-up on chronic conditions, or their annual physical for their employment or even playing sports. Soft marketing to the patient consistent with the treatment plan defined in the clinical note improves the patient engagement and allows the practice to proactively monitor revenue. A report that highlights the last time the patient was seen and the reason the appointment was schedule will facilitate these follow-up reminders.
Small changes in the way information is shared can have a positive impact on the revenue of the practice which directly impacts the financial success of the billing company. It is time to leverage the data available within the EHR and PM software to make those small changes.
Optimizing Revenue Cycle Management with Practice EHR
Practice EHR is transforming revenue cycle management for healthcare organizations of all sizes and specialties. Our platform helps you manage a smarter practice, by integrating key functions into one solution. From gathering patient data prior to check in, allowing the patients to schedule their own appointments to streamlining the clinical notes, filing claims, and allowing the patients to make payments from a text message. Practice EHR is truly, “The ONE” for all your medical practices needs.
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