A Tool for Evaluating the Strengths and Weaknesses of Employed Physician Practices
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