Revenue Cycle Management Blog | GroupOne Health Source

Conducting a Mid-Year Checkup of Your Revenue Cycle Management

Written by Ricki Ransom | July 1, 2016

A healthy medical practice centers around patient care and healthy revenue cycle management. You cannot have one without the other. In this day and age, no matter how good your practice is at keeping your patients healthy, if you don’t also have a healthy revenue cycle, you’re not going to be around long enough to help many patients heal.

It is crucial to take good care of your revenue cycle with a solid understanding of its efficiency, profitability, results and any opportunities that could make the revenue cycle stronger and work better for both your patients and your practice.

Schedule Regular Revenue Cycle Check Ins

You should have several check-ins: daily, weekly, monthly and mid-year that help you assess the health of your revenue cycle and whether or not you are hitting your targets.

If you see anything that alarms you, these are the moments that you can dig a little deeper to find out whether your staff needs training, you have a high ratio of patients with high deductible insurance, or if some other factor is impeding your revenue growth.

To conduct a mid-year checkup of your revenue cycle, make sure to include the following metrics in your analysis:

  • Review outstanding A/R (billed, value and days)
  • Review monthly production by doctor
  • Review denial activity during month
  • Review reverse aging of payments (payments received during month for what billing month did they pertain)
  • Percentage of claims denied overall, and by payer
  • Percentage of no-response claims overall, and by payer
  • Average life of denials and no-response incidents
  • Denials by category (over time, a larger percentage should be due to payer error and/or request for further info, not due to practice mistakes)

You need to focus on the broad measurements of your revenue cycle management health, and leave fine details for the daily and weekly checks.

[Also: Revenue Cycle Management Outsourcing on the Increase]

What’s Working, What’s Not Working

At mid-year, you can assess your practice in terms of what is working and what is not working. Are you getting optimal results, and if not, what needs to change?

With daily, weekly and monthly check ins, you aren’t able to have that long term perspective, but at mid-year, you have enough data to make some decisions.

Look at trends in each of the metrics above: are you noticing that your bills are being collected in a shorter amount of time? Great. If not, can you see whether this is due to inefficient online payment plans, a high percentage of high deductible patients, or a high percentage of denials?

Can you see trends in billing mistakes made by your practice? Note areas where training may be warranted. Also note improvements and make sure to let your staff know what has worked.

Getting Lean and Efficient

Again, at mid-year, you can look at overall systems and find ways to increase efficiency. You don’t want to micro-manage your systems (or staff!) but at mid-year, you can look at broad trends and find ways to fine tune your process to reduce waste in both time and money.

One way to do this is to leverage your Electronic Health Records Software (EHR) and Practice Management (PM) system. Consider more training for staff if necessary, and look into ways you can automate as many tasks as possible to free up time going forward.

Are You Profitable?

This is also the time to assess profitability. The shorter term benchmarks will not give you an accurate idea of profitability, but by mid-year, you have enough data to definitively tell whether your practice is profitable.

You also have time to reverse a negative trend, tighten up processes, and make the changes required if you find that you are not profitable.

Comparison to Industry

This is also the time to look more closely at your practice compared to others. Depending on the size of your practice and how much time and money you want to allocate to this, you can take a look at industry benchmarks and trends such as this report by IBISWorld.

It may be enough for you to see your practice trending in the right direction over time. You may not need to spend the time and money necessary to compare your results with industry standards.

However, this is an excellent way to tell whether results you are seeing are due to larger trends in the industry. It can also help with forecasting and making smart decisions about how to allocate resources for the mid and long term.

[Also: Managing The Revenue Cycle: 7 Areas for Improvement]

Look for Opportunity

Finally, look for opportunities. A mid-year check up is the perfect time to take a step back and look for ways you might improve and take advantage of opportunities presented to you.

Perhaps there is a new procedure that could save time and money? Perhaps you notice that a training opportunity has come up that could boost staff morale and also save you time and money in the future. A mid-year check up is a perfect chance to opportunities you may have missed if you had not paused to look.