The Employed Physician Revenue Cycle
Asking the following questions can help healthcare leaders evaluate the revenue cycle strengths and weaknesses of employed physician practices.
- Does the practice verify insurance info (using batch eligibility) prior to appointments?
- Are the patients informed of payment expectations prior to arrival for their appointment?
- Is the staff trained to collect co-pays, deductibles and past-due balances at check-in?
- Does the practice have a written financial policy that is provided to all patients?
- Does the practice verify coverage for specific services?
- Does the practice update procedure and diagnosis codes annually, as well as perform a coding audit?
Charge Capture/Claim Submission
- Does the practice capture 100% of office and hospital charges?
- What is the lag time from date of service to date of claim submission?
- Are claims submitted daily?
- Does the practice use electronic funds transfers (EFTs) and electronic remittance advices (ERAs)?
- Does the practice load payer allowables and track payment variances?
- Does the practice track denials?
- Does the practice monitor write-offs and have an appeals process?
Accounts Receivable Follow-up
- Does the practice follow up on all outstanding balances: payer and patient?
- Does the practice have a dashboard report that is reviewed monthly and compared to industry standards?
Source: Health Directions
Lucy Zielinski is vice president of Health Directions, LLC, Chicago (firstname.lastname@example.org).
James Valek, MD, is founder of LCMH-Vista Family Medicine, Chicago (email@example.com).
Publication Date: Thursday, December 01, 2011