Revenue cycle management includes all administrative and clinical functions that contribute to the management and collection of patient service revenue. But do you know where it begins?
It all starts at the front desk when a patient schedules an appointment. If this step is not handled appropriately and all necessary information obtained the entire revenue cycle can break down. Errors in this first step can lead to delayed payments or no payment at all.
Registration errors are one of the biggest causes of non-clinical denials by payers. Non-clinical errors can include an incorrect date of birth, not verifying eligibility and benefits, misspelling the patient or guarantor's name, selecting the wrong insurance company, etc.
When verifying insurance coverage you not only need to make sure the patient has active coverage for the date of service but also the patient has benefits for the service requested. Another important aspect of insurance verification is authorization and referrals. Is the insurance an HMO and a referral from the patient's primary care provider required? Is authorization required for the service? All these questions should be resolved before the service is rendered. Many insurances will not allow an authorization or referral to be backdated. Failure to obtain a referral or authorization results in lost revenue.
It is critically important to monitor denials on a daily basis to identify how much denial ratio is generated from these clerical errors.
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