Revenue Cycle Management – Look Out for the Red Flags!

Standard practice management benchmarks or targets on your revenue cycle reports may reflect an excellent position on the surface. However, unless you understand the underlying system architecture and dig deeper to understand the report build, it’s easy to become complacent because the reports indicate adherence to targets. When some numbers seem to be “off,” it’s essential to trust your intuition and invest the time to understand and validate the data fully.

Here are several examples of red flags we’ve encountered that should trigger additional investigation:

  • Days in accounts receivable is declining, even though there are a significant number of claims pending release to a specific payer
  • Lack of validation that claims are being paid based on current negotiated contracts or allowable schedules
  • Cannot reconcile services rendered to charges entered and claims released
  • The claims clearinghouse reports a significant number of paper claims submitted
  • Claim denials are increasing, particularly due to exceeding timely filing limits
  • Lack of a system super-user to keep current on updates and provide staff orientation and ongoing training

As these opportunities are interrelated, it can be challenging to determine how to prioritize, quantify, and address multiples issues. Day-to-day operations, personnel/provider management, and addressing patient issues often can distract or take priority over a thorough operational performance review. However, the return-on-the investment of time and money usually flags the gaps that may have hindered your group’s performance since the implementation of the original system.If you’d like to learn more about how our Physician Services team can support your revenue cycle operations, please contact us today.

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