How efficient is your practice’s revenue cycle? If you’re like most practices, that question would have to be answered with another question: How can I tell?
There are lots of resources you can use to benchmark your key revenue cycle indicators against those of peer practices. The American Medical Association (AMA), MGMA-ACMPE, American Medical Group Association (AMGA), and other professional and specialty societies all have benchmark data available. You can also look at the past few years’ worth of your own historical data to trend revenue, income, days in A/R, rejections, denials and more.
After you analyze your data and set benchmarks, what’s next? How can you use the data to improve your workflows?
Start by digging into the root causes of any revenue cycle weaknesses you’ve identified. At a global level, review all of the related processes that occur among your providers, staff, EHR and other IT systems. For instance, practices suffering from high denial rates might want to check:
- Where the denials are originating: Front end data entry errors? Inaccurate coding? Providers not credentialed?
- Type of denial: CCI edits/bundling? Non-eligible services?
In this example, look for the least labor-intensive ways to mitigate those problems. The key to workflow efficiency is ensuring that all the information you need to address your challenges is quickly, easily and consistently in front of you. For instance, simple tools can help you track and trend denials with a mouse-click instead of with multiple spreadsheets. Solutions that automatically pre-populate appeals letters with the correct patient demographic data prevent the need to waste valuable staff time to dig that information out of file cabinets.
Efficiently working denials and appeals is essential in today’s environment, where declining payer reimbursement makes it imperative to fight for every dollar earned. With an effective workflow mechanism in place, it’s much easier to keep denials, appeals—and the dollars they represent—from getting lost in the daily shuffle.
While it’s important to make sure this part of your revenue cycle is efficient, don’t forget all the other components. For more information about managing all aspects of your practice’s revenue cycle, download this white paper Seven Steps to Improve Your Practice’s Revenue Cycle Management.