Revenue Cycle Management/ Improvement

Are you collecting all the available revenue from your physician practices? Are you confident that claim reimbursement is according to your contracts?

Physician practice revenue management is a multi-tiered process. It begins with collection of accurate data at the receptionist desk; obtaining accurate health insurance information and collection of co-pays, deductibles and co-insurance. The provider must accurately capture and code the services provided. The insurance claim must be filed in a timely manner and accurately processed by the clearing house. The claim must be monitored for timely payment. The payment processors must adjudicate the claims appropriately, assigning the proper payment and adjustment codes. Finally, an effective patient account follow up system of letters, statements and telephone contact must be employed.

MMA’s Revenue Cycle Management Analysis and Improvement Program reviews the current processes, identifies problem areas and provides solutions that will improve efficiency and increase performance.

Our scope of services includes:

  • Analysis of the practice’s performance statistics, including an assessment of collection trends benchmarked to national norms as appropriate.
  • Assessment of billing office operations, including a review of operational policies (including those on financial policies, refunds, credentialing, coding and ancillary services) and CBO operational procedures (including financial controls, accounts receivable management and staffing and work distribution).
  • The better part of two (2) days will be spent evaluating operations in the CBO and at the practices, where applicable.
  • Interview key staff
  • Review accounts for appropriate charge posting
  • Review EOBs compared to patient accounts for appropriate payment and adjustment posting
  • Review payment controls
  • Review the practice’s policy for managing insurance and patient accounts
  • Review accounts to determine the level of follow-up activities
  • Identify problem areas
  • Report of our findings and recommended solutions.
  • Action plans
  • Implementation assistance
  • Performance monitoring
  • Education and coaching