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As the cost of providing healthcare increases and reimbursement rates decrease, collecting the maximum revenue due needs to be the highest priority for your practice or facility.

Every process in the revenue cycle from scheduling through billing and collections needs to be reviewed to ensure the best possible results. It is very important to have a strong line of communication between your front desk staff and your billing staff since small errors in any area of the revenue cycle process can result in lost revenue.

The following tasks will improve the cash flow of your business:

• Obtaining the correct demographics, insurance information and eligibility for a patient at the front desk is key for efficient claims processing and will reduce denials for timely-filing issues.

• Tracking no-show patients as well as contacting patients for follow-up visits and/or procedures that they did not previously schedule will increase patient volume and revenue.

• Encounter Forms should be reviewed and updated on an annual basis due to the numerous ICD-9-CM diagnosis codes and CPT procedure code changes that occur. Removing deleted codes and adding new codes for the current year will ensure that claims won’t be denied for non-valid code submission. Paying close attention to the addition of 4th and 5th digits for more specificity of diagnosis codes will reduce claim denials and support medical necessity along with your documentation for higher-level Evaluation and Management (E/M) services and/or procedures.

• Obtaining an independent review of your coding and documentation should address many areas that could affect your revenue. In addition to determining if the provider’s documentation is supporting the procedure codes being billed, it can also uncover charges not being billed.

• Be certain that you are utilizing appropriate modifiers and reviewing the Correct Coding Initiative (CCI) edits to ensure you’re capturing all billable items.

• Review your current fee schedules, reimbursement schedules and Explanation of Benefits (EOB’s) for incorrect reimbursement and/or downcoding.

• Proactively negotiate your managed care contracts.

• Improve the effectiveness of your collection process. Set up timings for follow-up and utilize the appropriate number of staff.