January 25, 2021 - Removing Interferences to Your Revenue by Brandy Brimhall

January 25, 2021 Puzzle Piece

Removing Interferences to Your Revenue by Brandy Brimhall

• Rejected or denied claims
• Over-the-counter collection uncertainties
• Inability to properly communicate with patients regarding financial responsibilities
• Aging accounts receivable balances - including patient and insurance balances
• Stifled cash flow and collections
• Practice workforce uncertainties and frustrations
• Loss of valuable provider or CA time tending to revenue cycle challenges
• Audit and compliance related vulnerabilities

• If you only have one person who knows what to do, when tasks should be done and how to accomplish them it can be a problem.  This scenario creates immeasurable vulnerabilities to providers because they are extending a blind trust in the financial health of their entire practice - even those with a superstar CA at the helm of these processes.  When that CA moves on or takes time off, the many keys to the revenue cycle system go with them.  Have cross training and backup knowledge for each position.

• It takes weeks and sometimes several months to really learn and become comfortable with some job duties.  The many parts of the RCS are certainly no exception.  Adding an additional team member or replacing an existing team member generally relies on too brief person-to-person training, which results in:  misunderstandings, confusion, essential skipped components, limited-to-no checks and balances, with elements slipping through the cracks.  In many cases where adequate understanding and training is critical, the baton simply does not adequately get passed on, or is simply dropped.  Most of the time without anyone even realizing it until incoming collections and cash flow are restricted or stopped, leaving the practice to worry about what happened, when and how. 

• Many CAs find that they must create their own systems and procedures, often without the tools and resources that would be necessary to give them certainty and confidence in their job.  Sometimes those in charge of billing and collections did not even realize that was going to be their role when they were hired.  They have limited to no understanding of coding requirements, what’s necessary for clean claims and submission, how payor policies and network requirements apply, the necessity of state law knowledge for both insurance and self-pay patients, and the list goes on.  Often when asking why something is done a certain way, I am told, “we just do it this way because that’s what we’ve always done”. 

• The revenue cycle system is quite complex – far more than simply just billing and collecting.  Consider the following components:  insurance verifications, electronic and paper claims, federal payors, Personal Injury and Work Comp payors, patient financial communications, over-the-counter collections, rejection management, claims processing and posting, in-/out-of-network guidelines, patient invoicing, non-covered or alternative treatment procedures, correct coding, claims review and posting, self-pay patients, appeals, follow-up and aged receivable management, etc. 

• This is a limited list of RCS components.  Not doing at least all these steps brings loss of revenue and practice harmony.  It is very easy to get stuck in the daily mechanics of data entry and billing while many of the crucial components to the revenue cycle system are set to the side, forgotten about, or never even known, much less fully understood!

• There are many hats most CAs in a practice wear on a day-to-day basis.  Even the most talented CAs can find themselves constantly playing catch-up and with a growing to-do list that there never seems time for.  In this scenario, it is often those revenue cycle -related tasks that may be more time consuming that are set to the side and left unattended (subluxated), which costs you serious dollars lost. 

• Unattended or poorly attended systems will result in a growing restriction of cash flow.  The older the balance (from patients and payors), the more difficult it becomes to collect and the more costly it becomes to the practice.  Motion is a sign of life – water, air, blood, and even cash flows.  Stagnant monies in billing, collections and accounts receivable systems have many detrimental long-term affects to a practice. These interferences minimize growth, expansion, workforce confidence, efficiency, patient relationships, practice overall value, financial health, and balance if your life and practice.