MDNews - San Antonio

DOES YOUR STAFF THINK THOSE WHO WORK IN THE BILLING DEPARTMENT ARE THE ONLY STAFF MEMBERS RESPONSIBLE FOR THE RE VENUE CYCLE? IF THE Y DO, YOU MAY WANT TO HAVE AN IMPROMPTU STAFF MEE TING TO DISCUSS HOW E VERYONE PL AYS A ROLE IN THE RE VENUE CYCLE. THE FRONT DE SK (administrative) sta , clinical sta , provid- ers, billing sta and the practice manager all are important to ensuring the practice maximizes the revenue generated. Some sta members may think the revenue cycle starts when the billing department receives the closed chart from the provider; however, this is not the case. The revenue cycle starts when a patient calls the o™ce to schedule an appointment and continues until there is a zero balance on the patient's billing account. The front desk sta is responsible for: + Creating the patient 's medica l record and obtaining the patient's demographic and insurance information. They need to ensure the patient's name is spelled exactly as it is on the insurance card. If this information is not entered correctly the claim will be rejected or denied. + Asking the patient at the appointment if there have been any changes in his or her personal information or insurance, and updating the demographics in the practice management system + Asking for a copy of the patient's photo identification and insurance card at least every three months to ensure nothing has changed + Verif ing insura nce covera ge a nd benef its prior to the patient's appointment + Ensuring referrals and prior authorization have been obtained prior to appointment + Collecting the appropriate co-payment, deductibles and co-insurance on every patient at either check-in or check-out. If your o™ce sta is not collecting the patient's payment responsibility, the practice could be violating your participation agreement with the insurance payers. If the appointment reminder phone call is made by a member of your sta , this is another opportunity that could enhance the revenue cycle. The front desk sta should be coordinating their reminder phone calls with the billing sta to determine if a patient has an outstanding balance. The reminder phone call should include a discussion of any unpaid balance and ask if they would like to settle that unpaid amount today using a credit card. The clinical sta 's role includes appropriately documenting the medical record, to include vital signs, lab results and supplies used during a procedure. In many practices, the clinical sta takes on an additional role as "scribe" for the provider, which allows the provider more time for the patient encounter. Those in physician and nonphysician provider roles must also appropriately document the patient encounter in the medical record to include prescriptions provided, lab or radiologic studies, orders, follow-up instructions, and similar comments. Their documenta- tion is used to determine CPT and ICD-10 codes for the visit. The number of patients seen per day and the type of medical services provided is an important aspect of the revenue cycle. The billing sta , whether in-house or outsourced, plays a major role in the revenue cycle. Their duties include: + Scrubbing the claim to ensure all CPT and ICD-10 codes are appropriate for the encounter + Entering charges in the practice management system in a timely manner + Submitting the claim to the clearinghouse for payment within timely filing deadlines of each insurance payer + Posting payments received from the patient and/or insur- ance payer + Sending patient statements on a monthly basis Everyone's Job in the Medical Practice Has an Impact on the Revenue Cycle BY TOM TIDWELL 1 4❱❱❱❱❱ P R A C T I C E M A N A G E M E N T

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