REVENUE ANALYSIS AND MANAGEMENT

Revenue is something which needs to be analyzed and managed like any other practice resource. It depends upon, not only the number of patients which come through the door of a practice, but also the mix of procedures or services done for the patients and the payer mix which reflects the reimbursement support the patients in the practice bring to the equation.  Usually, getting more money into a practice does not merely mean doing more, but it may mean doing different things for a different mix of patients and billing them on an optimal level.

The following questions may assist in the analysis:

  1. Do we know what is being done and for whom?  Are we aware of our patient mix and, at the end of the day, do we audit the registration or charge slips to be sure that we have captured all of the services which have been provided?  Do we have an idea that each physician is charging for what they do?
    1. This is a function of not only registration, but also of auditing the physicians’ behavior.
    2. Are we charging for telephone consults?  Are we charging for all physician visits not in the office — hospital visits?
  2. If we do something, is it charged?  Do we have a tracking to see that all of the slips get to some sort of billing point?
  3. Are we charging the optimal amount for each service?
    1. When did we last review our charges relative to the marketplace and the locally allowable billing schedules?
    2. Do we have a current rate being paid by all managed care companies for our services?
  4. If the charges are registered at the optimal amount, are they billed?  Are they billed in a timely fashion?  Are we taking advantage of timing with respect to electronic billing?  Are we billing procedures of more expensive services sooner?
  5. Are will billing it right the first time?  Are the codes and the background information appropriate?  Is the documentation appropriate?  If we bill at the appropriate rate, and it is properly coded, is the payment appropriate?  Do we assume that the payers pay at the proper level, and do we challenge their assumptions about the amounts which they pay?  They audit us, do we audit them?
  6. If we are billing, and if third-party payment is appropriate, is the co-payment or deductible collected?
  7. If procedures are billed and a third party rejects payment, are rejection inquiries answered in a timely fashion?  Is the patient informed of the rejection?  Is the billing modified or appealed?
  8. If payment is not received from the third party, and if co-payment or deductibles are not collected at the time of visit, does the patient receive a bill in a timely fashion?  Is the bill correct?  Are the results of our collection efforts efficient?
  9. If we are unsuccessful in collecting, is there an analysis to see what has been done with respect to the process which could improve this ratio?  Are we writing off things in an appropriate fashion?
  10. If we see a patient (or have experience with a provider or payer) who is a consistently delinquent participant, are we re-evaluating our relationship with them?
  11. Do we have a rationale for accepting assignment or not accepting assignment?
  12. Do we have a rationale, protocol or policy for determining whether or not a charge should be written off or whether a bill should be reduced in a special case of some sort?
  13. Do we audit our own processes on a regular basis so that we learn from our mistakes and our errors?
  14. Do we have a valid compliance plan in place?
Print This Page Print This Page