A lot of people understand that the revenue cycle deals with money, but beyond that many of them don't really understand what it refers to, Michael Orseno, revenue cycle director for Regent Revenue Cycle Management, said at the Becker's ASC 22nd Annual Meeting — The Business and Operations of ASCs.
Regent Revenue Cycle Management implemented ZirMed's RCM clearinghouse software in all 22 of its Midwest region's surgical health management facilities and most of its billing centers to help streamline the management of the combined front office, back office, pre-op and post-op procedures that make up the cycle in an ASC.
Revenue cycle used to refer to the management of linear processes between front office and back office, according to Mr. Orseno, but that definition has changed over time.
"What really makes it a revenue cycle is the feedback mechanism from the back office to the front office," he said "In the past the back office would struggle with the issues the front office would have, so when they would transpose registration numbers or not collect the right demographic insurance it would cause headaches for the back end. So this whole revenue cycle piece was invented and defined."
Here are some best RCM practice recommendations from the conference.
For pre-visit:
1. Verify eligibility, co-pay, deductible amount, remaining deductible and coinsurance electronically.
2. Collect and arrange for payment up front. That means collecting the patient's credit card information once the claim has been adjudicated and notifying them approximately how much it will cost and authorizing the credit card amount and storing the information to use it charge the exact amount. There are platforms that allow you to do that process electronically so it's more manageable.
3. Collecting up front may not always be the best option depending on the size of your out-of-network population, security concerns or contract limitations.
4. Calling patients to verify benefits, double-check demographics, explain out-of-pocket costs and ultimately arranging for payment.
For post-visit:
1. Look at your charge lag, which is the time between date-of-service and charge entry. The gold standard is typically 48 hours. Procedure takes places, is coded and then entered. Claim lag works the same way; it should take no longer than 48 hours and should be submitted at the exact same time as the charge.
2. All remittance should be received electronically. As explanations of benefit are coming in they need to be matched up with payments.
3. Most systems now allow auto-posting. So once payments are matched up with contractual allowances, you can see what payments are coming in, how much should be coming in, and you can set up your system to flag them for follow up
4. Equip your business staff with dual monitors to increase efficiency. It seems like a small detail but spending $150 or $200 on a second monitor saves so much in efficiency it shouldn't be a question.
5. Scan all correspondence into the patient's file.
6. Research denials when they come back and determine if they can be re-billed. There are three opportunities to follow up and you should take all of them.
7. As you get those denials provide feedback to the front end about where they are coming from.