Is Everyone in Your Practice Fulfilling their Role in the Revenue Cycle?

February 11, 2016 | By Ami Tucker

There is no one, and I do mean no one, in your medical practice who does not have a serious impact on the Revenue Cycle.

Providing services to patients is the business of healthcare. Every physician should understand the business processes that support their practice. This does not outweigh the fact that you are privileged to care for patients, but as the saying goes “No money, no mission.”

  • It takes a team to produce care. The roles of receptionist, scheduling, nursing, billing and physician must come together to share their knowledge and produce a high-quality, reimbursable patient visit. The patient calls for an appointment and the scheduler matches the patient’s problem to an appropriate appointment type. The scheduler finds out if the patient is new or established and what the patient’s appointment is for.
  • The patient arrives for the appointment and receptionist obtains all current demographic and insurance information.
  • The nurse rooms the patient, taking vitals, reviewing medications and reviewing the reason for the visit– the chief complaint.
  • The physician or mid-level provider cares for the patient, documenting the visit and choosing the appropriate service and diagnosis codes.
  • The patient completes the visit by paying any deductibles or co-insurance due and making any future appointments needed.
  • The billing team enters the payments and/or charges if the service codes have not already been posted via the EMR.
  • The biller scrubs the claim, checking for any errors and electronically submits the claim to the payer. The hope is that the claim is clean and will be accepted and paid immediately (within 30 days.)
  • If the claim is denied, the biller relies on the documentation prepared by the medical team (scheduler, receptionist, nurse, physician) to create an effective appeal to support medical necessity.

You will achieve a substantial increase in employee satisfaction, retention and performance when each staff member understands how important her contribution is to the delivery of care and the financial success of the practice. Take a few minutes in your next staff meeting to review these roles for your own understanding and the support of your practice.

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