Audit, Assessment or Both? Evaluating Revenue Cycles in Practice
Sometimes physician practices need a focused audit. Occasionally a complete process assessment and re-engineering plan fits the bill. And on other days, the practice isn’t exactly sure what corrective action to take. They simply know the revenue cycle is broken and something must change.
Recently I worked with a busy pain clinic in Southern California. We started with a simple practice assessment, but ended up completely re-engineering the revenue cycle. Here are the highlights!
Symptom: A large, unexplained rise in accounts receivables.
Underlying Cause:
- Payor contracts could not be found and when reimbursement checks did arrive, they were often in the wrongname (still addressed to practice’s original founder).
- Coding and billing staff were very experienced, but lacked high-level understanding of the revenue cycle.
- Knowledge of evaluation and management (E&M) guidelines and medical necessity documentationrequirements was out of date.
- Medical assistants and other staff had good ideas, but mismatched roles and duties.
Corrective Measures:
- Interviewed staff to identify each employee’s passions, areas of interest, career goals, earning expectations,weak points and insecurities.
- Evaluated current roles and workflow; renamed some positions, eliminated some positions and added a few.
- Established new process workflows, educated staff and explained recommendations made.
- Educated everyone on the importance of correct coding, requirements for meeting medical necessityguidelines, LCDs, NCDs, E&M criteria, and payer relationships.
At the end of the month, everyone understood the value of correct coding and its impact to the practice’s revenue cycle. They began working as a cohesive team as the focus shifted from reactive to proactive accounts receivable (AR) management. Finally, they aligned job responsibilities with each individual’s strengths and by doing so, achieved optimal performance from each and every employee.
In the final analysis, everyone had positive intent. And so does everyone in your practice! An external set of eyes and ears made all the difference and quickly led to a stronger, more cohesive organization. Perhaps it’s time for every practice to consider the same.
Where will I find training on educating physician on documentation requirement?
There are a couple immediate options available to you for training physicians on requisite documentation.
The first ‘training’ option is really better described as research or identification of authoritative material that you can add to your list of ‘go-to’ sources. In this case, you should consider researching CMS’ website http://www.cms.gov, and the MAC website for your specific MAC location. Here you will find great information to use in your efforts to educate your physicians and even building reference guides and templates that will assist them in their efforts. Another ‘go-to’ source alternative is EM University http://www.emuniversity.com
If this is just more than you want to take on right now hiring a consultant is one of the fastest and most effective ways to bring about results you seek. A consultant is a great, objective ally in your efforts to educate physicians and improve the clinical specificity of their documentation. Most come prepared with time-tested tools and processes to ensure positive change.
Regardless of which of the option you choose, it is NEVER too early to begin this effort. Accurate clinical documentation is a vital component in your efforts to receive appropriate reimbursement and protect yourself from future recoupment. If you need any additional help, please let me know Deborah.Robb@TrustHCS.com
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