The business of medicine is not a new concept, but it is becoming increasingly important. Every dollar counts and the physician practices that grasp and master the essential revenue cycle management concepts will be those that find sustainability in a changing healthcare landscape.
Tackling the stumbling blocks
Patient education goes a long way to keep any physician practice's revenue cycle running smoothly. The billing system is undeniably confusing, not only for patients, but even healthcare professionals. "GI practices have always had a challenge educating a patient on the coding, billing and reimbursement issues that arise when a patient has assumed that their colonoscopy is a 'screening colonoscopy' and therefore should be covered at 100 percent," says Barbara Tauscher, MHA, FACMPE, AGA Institute Practice Management and Economics Committee member and director of gastroenterology – east and south divisions at The Oregon Clinic. "This challenge is magnified when the patient has a high deductible and is responsible for paying the entire balance."
Take the time to explain what patients owe, when it is expected by and how they can pay. "It's easier and often cheaper to spend the time and effort at the front end of the revenue cycle versus the back end," says Ms. Tauscher. "We have a financial counselor on-site who calls all of the patients on the endoscopy schedule that may have their charges applied to their deductible." A lack of established collection processes is a second major obstacle to effective revenue cycle management. Even if patients are educated, payment can slip through the cracks when there is no standardized method for accepting these payments and tracking patient accounts.
Limiting your resources slow the revenue cycle process significantly. "Leverage the convenience of online credit card collection services. A few years ago, we added a simple 'Pay Your Bill' online icon to our website. Within six hours of adding the icon, we had our first patient payment," she says. "When we allowed the patient to set up their own online payment plan, it really saved our collections staff a lot of time and needless phone calls."
RCM dashboard
GI practices need to track and manage revenue cycle management processes to ensure they are working and no money is left on the table. Here are three essential metrics to track, according to Ms. Tauscher.
• Balances past 90 days. "Make sure you know the balances in the 90, 120 and 120-plus aging categories and how that compares to national benchmarks, as well as your own benchmarks (i.e. how does that compare to your aging balances last year?). Then ask yourself how you could improve. If you don't currently ask for pre-procedure deposits, should you? Are the majority of the balances associated with high deductible accounts where the patient has seen you for a procedure only? Or is it due to uninsured patients that you have seen in the hospital?"
• Co-pays and balance on accounts. "Each practice should collect 95 percent to 98 percent of the office co-payments. Most of us are pretty good at this. But, how many patients have an office visit today, that have a balance on account that is 60 days old? Can your practice management system provide you with a report of all patients scheduled for a particular day who have a balance over 60 days old? If so, have your staff call those patients to request the payment before the visit, or have the patient pay it along with their co-payment when they arrive for the office visit."
• Denials. "What's getting denied and why? I usually track denials in three categories eligibility and referrals, coding and other. The eligibility and referral denials usually indicate that our staff needs additional training or a workflow needs to be updated. Coding denials are often associated with specific carrier rules. Once we track the pattern of coding denials, we can build those rules into the claims scrubber, or at least tag those claims for review before they are sent. 'Other' is a catch-all category. Each of the denials in this category requires some investigation to find the root cause of the denial."
Considering new payment models
New payment models are coming to the forefront, and chief among these models is the concept of bundled payments. When taking on bundled payments it is important to consider how this will impact revenue cycle processes. "If bundled payment are used for ALL colonoscopies and not just for screening colonoscopies, then the revenue cycle management process should become much easier," says Ms. Tauscher. "If the bundled payment amount is paid by the insurance carrier regardless of the patient's unmet deductible, then the practice will have few costs associated with coding, claims management or collections. Instead, our focus will be on cost accounting."
Opportunities for financial success
Despite the challenges presented by today's medical field, there remain significant opportunities for financial success. Workflow efficiencies can improve practices' day-to-day operations, cut down on unnecessary expenses and boost revenue. Technology, such as a new test, device or practice management tool, can attract more patients and improve how practices are run. "As in any medical specialty, not just GI, the practice administrator will need to use every management tool they have, plus some creativity, to assure the practice's financial success in the future," says Ms. Tauscher.