Several years ago, Regional Urology began looking for an efficient way to improve business performance. We needed answers to figure out why claim denials were increasing, why our revenue was dropping despite a constant patient load, and why our days in A/R were regularly at 90 to 120 days. We realized we weren’t collecting full reimbursement on 10%-20% of the services we offered and knew some of our business processes were outdated.
Many of our processes at the time were inefficient and cumbersome, such as the manual eligibility verification process that wasn’t always done consistently or correctly. However, our biggest problem was that we couldn’t fully appreciate where processes were falling down. Our approach to revenue cycle management at that time didn’t include detailed reporting, so we didn’t know exactly what our problems were or how to fix them.
After doing some research, we turned to a web-based clearinghouse to automate a few of our key business processes, including eligibility verification, claims submission and patient statements. The system also offered comprehensive reporting that allowed us to examine claims in real time and uncover potential problems. For example, the system generates reports that show how many claims have inaccurate demographic data. This information revealed that we needed to tweak the way we collected demographic information from patients.
Automating our revenue cycle has proven to be a good decision. Our days in A/R have dropped to an average of 30-60 days—a decline of as much as 50% in three years. Preparing and submitting claims is easier than ever, and eligibility verification is more efficient and accurate. Bolstered by these results, we continue to look for ways to leverage technology to streamline processes, enhance our business performance and grow revenue.
About the author
Joel Young is the chief executive officer of Regional Urology, LLC, a multifaceted urology practice that supports clinical visits, radiation treatment, robotic surgery, CT scans, ultrasounds and research. The practice has a central billing office that is responsible for all aspects of the revenue cycle.