Revenue Cycle Management Series: Four Factors Affecting Revenue

Though using reports is a good tool to manage the revenue cycle and monitor its effectiveness, fluctuations in revenue are sure to occur at some point and time.  Below are the four factors most often at the center of revenue decreases.

  • Patient Volume: The total number of patients coming into a provider/practice, as well as a change to the payer mix, can impact revenue.
  • Staff Delay & Error: This can include errors in data entry, a backlog in the billing process and poor performance of job functions can all impact revenue. Timely filing deadlines, appeal cut-off dates and administrative adjustments can all lead to missed payments.
  • Coding & Billing: Lower coded claims, unidentified charges and lack of documentation can all lead to services not being properly billed.
  • Insurance Delays: Delays in insurance payments can result from insurance company errors, as well as credentialing issues.

Revenue Cycle Management Series: Denial Management

This installment of the HMS Healthcare Management Solutions series on Healthcare Revenue Cycle Management deals with denial management.

When a claim is denied, billing staff should attempt to resolve the denial by providing the additional information required by the payer to complete processing, appealing the denial with the payer of by seeking payment from the patient. Much like claim errors, denials delay the payment process and decrease the overall effectiveness of the revenue cycle.  Maintaining control of denial management is best accomplished by following a few simple steps:

  • Review denial reason codes regularly
  • Identify why a claim was denied
  • Make corrections to prevent similar future denials
  • Run and review denial reason reports monthly
  • Review office processes to eliminate errors that may lead to denials

Keeping denial rates low reduces the money in accounts receivable and contributes to effective revenue cycle management.

Revenue Cycle Management Series: Write-Offs

This installment of the HMS Healthcare Management Solutions blog series on Healthcare Revenue Cycle Management delves into write-offs.Monitoring write-offs is a sound internal control procedure which can protect against employee dishonesty or incompetency.  It’s important to remember adjustments tend to mirror receipts, not charges.

In a month where you have high receipts, you should expect above average adjustments. Look for unusual levels of Medicare and Medicaid postings during a month when adjustments don’t mirror cash receipts. Claim filing errors, inappropriate wrote-offs, bed debt and other posting errors can also be the culprit. Effective revenue cycle policies allow for several adjustment codes to accurately track adjustments.  Below is an example of codes that cover most circumstances.

  • Contractual Adjustment
  • Bad Debt
  • Research Study
  • Cash Discount
  • Courtesy Write Off
  • Promotional Discount
  • Account Correction

Remember, spending the time to define and manage adjustment options can create efficiency in managing this process more effectively.

New Year’s Resolution: Improve Practice Workflow with HMS

Physician practices have become increasingly complex, with data management needs competing with patients for time and attention.  In response, physicians are seeking better, more efficient ways to manage patient data, improve revenue cycles, reduce expenditures, decrease billing errors and streamline day-to-day operations.  That’s where HMS can help.

HMS Healthcare Management Solutions offers revenue cycle improvements, practice management assistance, EHR, as well as consulting and strategic services for physician practices and other health care providers.  We will leverage our knowledge and experience and invest our resources in creating partnerships that fundamentally change how profitability and success are achieved.

HMS believes the best way to help physicians survive and thrive in the ever changing environment is to transform the underlying infrastructure with a comprehensive and flexible system that allows them to take control of their practice.  At HMS, billing and coding is our only focus.  Our investment in the latest technology coupled with an experienced, highly-trained staff will not only improve your revenue and cash flow, it will give you more time to concentrate on what matters most  – caring for your patients.

What does all this mean to your practice? The HMS medical billing team will speeds up your cash flow by reducing error in the claims process for faster reimbursements, improved consistency and increased cash flow giving you a competitive advantage over practices without our resources at their disposal. The end result is a healthy, thriving practice with long term stability.

When you partner with HMS Healthcare Management Solutions, you’re adding a trusted member to your team.  We have over 25 years of in-depth knowledge of the health care business. Many of us started out as providers, so we understand your perspective and know how frustrating it can be to cope with daunting amounts of paperwork while delivering quality care. We understand the difficulties of planning for the future when you need to focus on the here and now.  Let us help you maximize your potential by increasing your financial performance.

Contact HMS Healthcare Management Solutions today!