Everyone is Part of the Revenue Cycle Department

A lot of processes need to go just right for claims to be reimbursed and paid appropriately. This starts with the registration process. It includes the providers submitting robust documentation, before it gets to the coders. This means, even if staff isn’t directly in the billing or revenue cycle department, they contribute to the success. Everyone on the team is part of the Revenue Cycle Department.?

There are some important KPIs to look at to see how healthy the revenue cycle is for an organization. Specific KPIs can help detect where in the revenue cycle improvements can be made.

Clean Claims Rate - This is an important measurement because it shows how many claims can go to submission without changes. If there is a low Clean Claims Rate, you can look for a few fixes:? Patient Demographic Data (registration staff) Payer Rules (scrubbing) etc.?

First Pass Resolution Rate - This is the rate of claims that are paid on the first go round. Having a high First Pass Resolution Rate is a good thing because it shows that the revenue cycle is moving smoothly. If it’s low, there are areas for improvement.?

Missed Charges - If a team is missing charges, it’s important to investigate why. It can be human error or a technology glitch. If money is being left on the table on a regular basis it’s important to nip it in the bud.?

Days in A/R - This shows how many days it takes to be reimbursed for services. The fewer the Days in A/R, the better the cash flow. Can you see how many days it takes claims to be submitted once the patients are treated? Can you see which payers take longer? Is there a workflow that adds days to this number? (Cough…documentation…cough)?

Denial Volume - Denials happen. Keeping denials to a minimum is vital, because recouping them can cost between $25 (ambulatory) - $119 (acute). Look to the denial codes for trends, and how to prevent them in the future.

For example,? If you see “Diagnosis Inconsistent with Procedure”? That’s likely an issue with coding, or documentation, check with the providers, scribes, and coders and see where the coaching needs to take place. “Expenses incurred after policy is terminated” code? That’s a front end eligibility issue. Working with registration staff to collect the appropriate information can help tighten this up. “Timely filing” denial code? That’s an issue to be investigated. What’s taking the claims so long to be submitted? There’s a lot to be inferred from the denial codes.?

If you need assistance with your revenue cycle, talk to PointWest to start recouping money.?