The document discusses a lunch and learn meeting for practice managers on revenue cycle management. It provides tips for managers to evaluate their operations in key areas like finances, billing, and collections. This includes establishing cash controls, tracking monthly performance, ensuring proper documentation and billing processes, and meeting industry benchmarks for accounts receivable and collection rates. The goal is for practices to manage their revenue cycle like a business to increase productivity, efficiency and overall revenues.

1. Palm Beach County Medical Society & Keiser University
LUNCH & LEARN
MANAGERS/ADMINISTRATORS MEETING
Wednesday, September 9th
,
2015
:

2. “Revenue Cycle Management”
SPEAKER
Juan H. Kouri, MHSA
Director Business Development
ProMD Practice Management

4. In times of declining/decreased revenue, Practice Managers must
evaluate their current operations to assure they are using a “best
practice” approach in the following key areas of their operations:
 Financial
 Practice Management System/EMR
 Billing & Collections – performance benchmarks

5.  Cash controls
◦ System generated receipts
◦ Patient payments posted by Front Desk & reconciled at end of
day (system to match actual cash collected)
◦ Daily practice reconciliation (“Daily Closing” should include total
revenue collected & deposited to bank)
 Monthly practice performance report generated to track/trend
performance
 Patient Registration Form should include financial liability verbiage
allowing practice to charge back patient for any collection fee
associated with non-payment

6.  Financial record keeping using accounting-type software (e.g.
QuickBooks) to track revenue & expenses
 Reconciliation of practice management system VS QuickBooks
 Workflow that ensures all patients are verified to confirm coverage,
identify patient’s financial responsibility, and collect at time of visit
 Employees aware of contractual amounts in order to collect co-
insurance & deductibles at time of service

7.  Fee schedules (insurance plans, Medicare, Medicaid, etc.) entered in
order for system to identify underpayments.
 EMR capability (interface with PM)
 Ability to generate system encounters
 Track “open” encounters via system report to assure all charges are
posted
 EMR system should be certified in order to qualify for stimulus monies.

8. The financial viability of a medical practice depends on the
performance outcomes of its physician billing process.
Establishing industry recognized benchmarks* for key
performance measures can assist in determining
whether your revenue cycle and account receivables are
performing at optimal levels.
* Benchmarks were established using Medical Group Management
Association (MGMA) industry standards in conjunction with ProMD
proprietary statistical data

9.  1. Proper Financial Responsibility documents
2. Correct and accurate patient Appointment
Scheduling & Registration
3. Copies of Insurance card and ID card
 4. Determination and collection of patient
responsibility (co-pays, deductibles and co-
insurance)
 5. Check-in and Check-pout process

10.  1. Charge Posting (Modifiers)
 2. Claim Submission
 3. Payment Posting
 4. Insurance Collections
 5. Guarantor Collections

11.  No. 11 on that MGMA report: collecting from self-pay patients or
those with high-deductible health plans
 Typically, front-desk personnel are interested in checking the
patient in and confirming and updating insurance coverage
information. Requesting payment from patients who may have
medical issues and want to visit with the doctor isn't easy

12. MGMA Perspective (Cont’d.)
 Understanding the different types of insurance coverage and plans
patients may have.
◦ Is the patient a self-pay patient?
◦ Do we only have to worry about collecting a copayment?
◦ Does the patient have a high-deductible that hasn't been met yet this
year?
◦ Will the patient have a coinsurance obligation that won't be known
until he or she is seen by the doctor?
 Each of these categories may trigger a different approach to collecting
on day of service. The collection process should be outlined for front-
desk staff in a practice's policies and procedures manual.

13. CPT CodesCPT Codes AetnaAetna BCBSBCBS UHCUHC
5745257452 364364 424424 $ 365$ 365
5943059430 252252 253253 $ 250$ 250
9921299212 7171 9090 $ 80$ 80

14.  A/R
◦ % > 120 days = 18% or less
◦ % < 61 days = 75% or greater
 Days in A/R
◦ 60 days or less
 The Net (or Gross) Collection Rate lets you know how much money
you collected of the money you could have collected
◦ the collection rate should be greater than 90% after 6 months
and greater than 95% after 9 months

15.  Manage your office like a business using proven business strategies that
increase productivity and efficiency
 Track & trend financial performance in order to identify any fluctuations that
might have a negative effect in office revenue
 Pre-verify all patients prior to visit
 Have full knowledge of your reimbursement rates in order to collect patient’s
financial responsibility
 Whether billing is outsourced or done in-house, monitor outcomes while
comparing to industry benchmarks
 Perform due-diligence when selecting PM/EMR system & apply for incentive
monies