The best way to ensure that you bring maximum revenue into your practice is to involve several key team members in the revenue cycle process so you can master every step along the way. And once you identify the participants, you’ll need to train them properly to keep the entire team running at maximum potential.
Check this primer to make sure you have the right members on your revenue cycle team so you can bring in every penny you deserve.
Front Desk Team
Your front desk staff is the oil that runs the revenue cycle engine. Every practice is different, but yours most likely has a receptionist on the team. You may also have a scheduler, but in some smaller practices, this can be the same person as the receptionist who greets patients when they arrive.
No matter how many people are part of your front desk team, they should know how imperative they are to the revenue cycle process. They capture the patient’s insurance information during the first call to schedule an appointment, enter that data into the system, and often call to pre-verify coverage. The number one reason for claim denials involves either data entry errors early in the process, or obtaining incorrect information from patients during scheduling, which means the front desk team is imperative to accurate billing since they capture and record this information.
Practice Manager
The practice manager is the first line of defense when credentialing and contracting with insurers, so that person is key to helping your practice set fees, evaluate coverage criteria, and confirm claims submission processes. The practice manager is also involved in choosing and setting up the electronic health record (EHR) and electronic claims submission processes, which are essential steps in the revenue cycle process.
Your practice manager should be able to set up the EHR system so you can verify that insurance payers are correctly reimbursing you for services by matching the total payment with the fee schedule. That person should also review data and create reports at the end of each month or billing cycle to evaluate how long claims are taking to process, the percentage of claims denied, what your charge entry rate is (how quickly payments and charges are being entered), how long patients are taking to pay, how many appeals you had to file, and other metrics to find areas for improvement.
Coder
Your coder or coding staff members are essential members of the revenue cycle team. They assign the most accurate codes to your claim so insurers can verify and price services. Coders also follow up with providers when the medical record doesn’t contain enough information to select the right codes.
The coding team will stay on top of coding changes and updates, and will determine whether claims require modifiers for payment. For instance, some payers require modifier 95 on telehealth claims, while others don’t. The coders will identify and track these nuances to ensure that the most accurate codes are assigned to claims to ensure that you’ll face fewer denials and that you’ll get paid for the services your providers perform.
Billing Team
Your billers create your practice’s batch claims submissions, ensure that claims are clean, and handle charge entries. They also work denials, process appeals and interface directly with your clearinghouse.
Every practice’s billing team should have an understanding of specific payer guidelines and know the nuances of how each insurer wants claims submitted and processed. A member of this team will also bill patients for any balances, track financial arrangements made with patients, and determine when accounts should be sent to collections.
Someone on the revenue cycle team should also be tracking and monitoring claims to catch issues before they become significant. That is often the biller, but may also be the coder, practice manager, or another team member.
Putting It All Together
Once you have your team members in place, your work isn’t done. You should be training staff members continually based on the month-end reports you create. If one area seems to be falling behind (such as appeals being processed too slowly), focus your training on that area. In addition, you should always be working with staff on training to keep up with the most updated regulations, codes, billing rules, and insurer processes.
Your revenue cycle will never be a “set it and forget it” process—you’ll always need to stay on top of it and tweak it along the way so you can improve. But by putting the right team members in place from the beginning, you’re on the right track to maximizing your practice’s revenue.
To get a firm grasp on creating your revenue cycle team, check out the online training session, Billing 101 for Practice Managers: Tips to Boost Revenue and Reduce Headaches, presented by Sherri Lewis, CPB. During the 60-minute training, you’ll find out how to assemble the most effective revenue cycle team and how to train them for maximum revenue.
 |
Subscribe to Healthcare Practice Advisor |
| Get actionable advice to help improve your practice’s reimbursement, compliance, and success in this weekly eNewsletter. |
|
|
|