post-picture2Sometimes 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  • Knowledge of evaluation and management (E&M) guidelines and medical necessity documentationrequirements was out of date.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.