The revenue cycle workflow is a set of sequential processes that begin with a scheduled appointment and ends with the reimbursement for services.
According to a survey by BESLER and HIMSS Media, the top revenue cycle challenges that can negatively impact organizations are claims denials, reimbursement, prior authorization, physician documentation, and coding. Nearly half of those surveyed cited claims denials as a risk to the revenue cycle; however, missteps in either of these areas can affect the financial well-being of medical organizations.
When monitoring revenue cycle processes it is important to recognize trends in specific areas. For example, not all claims are created equal. Claims can be denied for reasons ranging from incorrect patient insurance information to coding errors to insufficient documentation to support medical necessity. Therefore, denied claims should be reviewed and tracked to easily acknowledge where the problems are. If claims are denying because of incorrect patient insurance, attention should be directed to the registration staff for additional in-service opportunities. If claims are denying due to coding errors, it is time to speak with the coding team to determine if clinical documentation is sufficient to support code assignment.
Proficient revenue cycle management is integral to the financial well-being of healthcare organizations. Best practices include systematic monitoring of the entire revenue cycle workflow from end-to-end to minimize the risk of lost revenue. Another key factor in proficient revenue cycle management is tracking key performance indicators (KPI) like cash flow, days in accounts receivables (AR), first pass rate on claim submissions, and net collections. Healthcare organizations are only as strong as their financial stability. Assuring the revenue cycle is performing proficiently will solidify an organization’s financial viability and future performance for years to come.