Understanding Your Revenue Cycle

by | Feb 22, 2018

Whether you’re looking to grow your practice or simply want to make sure you can keep the lights on, your practice’s revenue cycle is essential. Unfortunately, this particular subject probably didn’t come up in med school. No need to worry, though – we’ve got you covered!

Today, we’re going to break down the revenue cycle into various components so you can better keep a pulse on the entire process and, at the same time, be able to identify areas for improvement.

To best illustrate the different areas of the revenue cycle, let’s use a hypothetical case study of one of your patients (Bob Jones) as he goes through two different office visits.

Naturally, the whole process begins with patient registration when Bob calls your office to request an appointment. Mary, one of your front-desk team members, interviews him over the phone to collect the necessary billing and insurance information.

Since Bob called ahead this time—his next visit is going to be a walk-in—Mary has the opportunity to verify his insurance eligibility prior to his appointment. While on the line, Bob has some questions about his coverage and she’s able to answer them for him.

After he gets off the phone, Bob can either enter the information online at your website or download and print the necessary paperwork, since he wants to save time at his appointment.

When Bob comes in next Thursday, he walks up to the front desk, Mary checks him in and verifies that he has completed all of the demographic and medical history information that your office needs, and takes a copy of his insurance card (front and back) for reference in the event that you need to contact the payer. As part of this process, Bob writes a check for his office visit copay. This obviously is a start to receiving the payment for medical services you provide, but it’s not the last step.

Since you want to make sure your practice receives the full amount it is entitled to receive from the insurance company, you implement the charge capture portion of the revenue cycle. This means that during Bob’s visit, you use your office’s system for ensuring all billable services are recorded – so they can be appropriately billed to Bob’s insurance provider.

The appropriate staff member will use your office’s charge posting, claims processing, payment posting, and reconciliation process for Bob’s case. Depending on your practice, this could be done in either a manual or automatic manner.
Automatic posting is a more efficient process – one that can drastically reduce the amount of work required by your staff. If your office still uses outdated processes, you may want to consider upgrading to automatic payment posting.

Once the billing process is completed, you will want to balance bill the patient for any charges that were deemed to be patient responsible that you didn’t collect at the time of the visit.  Statements should be sent to patients on a regular basis and tracked carefully for payment.  For the second scenario, Bob called that day to schedule an appointment.  He is a patient who happens to be lucky you had a last-minute appointment cancellation.

Now, Bob has already been to your office, but insurance situations change for patients all the time. So this means Mary at the front desk needs to use your office’s real-time insurance verification process. As with the scheduled appointment, she will still get a copy of his updated insurance card and collect Bob’s copay.

From that point forward, the rest of the revenue cycle is essentially the same as before.  Basic processes that can continue to have positive results.

Your ability to grow your practice—or even simply maintain its survival—is directly related to your ability to manage the revenue cycle. With that in mind, ask yourself this – do you have a firm grasp on your practice’s revenue cycle?

If you cannot confidently answer “yes”—no, “I think so” isn’t good enough—let’s chat! ING has been able to help doctors just like you develop sustainable growth, and we’d love to do the same for you.

Contact us today by calling (260) 927-1266.

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