Positioning your practice to succeed in the future starts with getting it right today. Practices are challenged with deteriorating collections, payer edits that erode negotiated fee schedules, ever increasing patient liability, staff skill-set gaps and more. The revenue cycle is the lifeblood of the practice and understanding strengths and weaknesses relative to best practices can provide a solid compass to optimize performance.
Revenue cycle processes and workflows begin at scheduling and end when the money is deposited in the bank. As depicted below, it is without question one of the most complicated payment flows that exist. Each segment of the cycle requires evaluation to ensure that processes are efficient and collections are maximized.
Our approach is comprehensive. We provide a current state assessment and compare your practice to peer groups and better performing practices. We pair the quantitative analysis with operations insights conducted through staff surveys and onsite interviews/observations, creating a 360º view of your revenue cycle.
The right people in the right roles.
Assess staff skill sets and roles.
Conduct gap analysis – current workflows to best practices.
Evaluate technology utilization.
Roadmap for improvement.
Understanding how much patient liability your practice collects compared to “potential” dollars tells you how well your front-end collections program is truly performing.
comes directly from patients
Source: MGMA 2010
Tracked Progress = Actual Collections / Possible Collections
Adjusted collections represent the amount collected based on estimated “collectable” dollars (aka net collections). Best practices collect a much higher portion of the collectable dollar. In the example below, this group collects $0.84 on the collectable dollar.
Unexpected adjustments are a road map for identifying opportunities in operations improvement. In the example below, there is significant opportunity in various categories for all practices.
|Credentialing Issues||$ 270,142||$ 20,996||$ 44,175||$ 82,736||$ 2,175||$ 420,224|
|Deceased||$ 22,273||$ 6,863||$ 14,507||$ 42,169||$ 954||$ 86,766|
|Out of Network||$ 11,949||$ –||$ 719||$ 7,842||$ 176||$ 20,686|
|Small Balance||$ 563||$ 1,985||$ 1,228||$ 1,298||$ 2,536||$ 7,610|
|Collections||$ 182,263||$ 142,447||$ 73,479||$ 239,825||$ 59,273||$ 697,287|
|Bankruptcy||$ 5,072||$ 879||$ 883||$ 13,232||$ 2,199||$ 22,265|
|Timely Filing||$ 412||$ 3,527||$ 425||$ 35||$ 562||$ 4,961|
|Patient Balance Discount||$ 8,891||$ 4,036||$ 2,632||$ 2,671||$ 3,314||$ 21,544|
|Administrative||$ 286,784||$ 12||$ 20||$ 165||$ 249||$ 287,230|
|Total||$ 788,349||$ 180,745||$ 138,068||$ 389,973||$ 71,438||$ 1,568,573|
We will provide you with a comprehensive assessment of your current performance and a practical guide to optimize workflows and increase efficiency. Our process includes education we readily share with your teams. We understand that when your teams appreciate the “why” behind our recommendations, it increases adoption of our proven recommendations. Our team can help implement recommendations with as little or as much assistance as you need.