Getting paid: Learn how to ride your revenue cycle

Knowing how a claim becomes cash can make the difference between struggling for reimbursement and receiving all you're owed.

By Julie A. Jacob, AMNews staff. April 15, 2002.

The flow of revenue coming into your practice is a cycle that starts when a patient schedules an appointment and ends when the payment is received.

Fine-tuning the revenue cycle and pinpointing steps where errors often occur can help ensure that the practice receives all of the reimbursement that it is due, said Lee Hedman, a managing associate with Health Directions in Chicago. Hedman discussed revenue cycle management at the Chicago Medical Society's Midwest Clinical Conference.

Physicians and their staff have to "look at the whole picture" of revenue collection, Hedman said at the late March conference. They have to know how all the pieces in the revenue process -- fee schedules, coding, claims processing and so on -- fit together in order to maximize the practice's revenue.

Physicians and their staff should periodically discuss the practice's billing system. "At least one time a year, sit down with your staff, flowchart the revenue process and see what is happening," she said. In other words, the staff should discuss each employee's responsibility in the claims-processing process and diagram the flow of claims and payments through the office.

That's also a good time to discuss changes and updates to codes and modifiers. Even minor errors caused by overlooked changes in modifiers or codes, can result in denied claims, said Hedman.

The process of getting reimbursed begins when a patient comes into the office for an appointment. At that time, the receptionist or billing clerk should verify the patient's insurance and address information. The database of patient information should be categorized in a way -- such as by patient phone number -- that is quick and easy for staff members to access and update it. [...]