Revenue Cycle Management is a process, not a department or a person. The skill set required for successful Revenue Cycle Management today requires a strategic approach to Accounts Receivable, Accounts Payable, Billing of all payer types, HIPAA Compliance and adherence to state and federal guidelines.

The Affordable Care Act (ACA) has helped to fund additional efforts toward Billing Compliance programs initiated to identify billing "Fraud and Abuse" by medical providers. The Recovery Audit (RA) Program, CERT, ZPIC and other efforts by the Office of the Inspector General (OIG) programs to date have returned several billions (yes billions!) of dollars to the Medicare program. These programs have a shared focus; to "preserve the Medicare trust" in anticipation of the impending "Age Wave" of baby boomers reaching the age of Social Security and Medicare eligibility.

Medical providers of all types need to establish clear policies and procedures for billing of services, being mindful of the top billing mistakes such as missing or inaccurate demographics, wrong dates of service, incorrect coding, inappropriate unbundling and lack of documentation by providers, etc. Whether handling Revenue Cycle Management in-house or via an outside consulting firm, it is critical to utilize a system of checks and balances such as Triple Check to review claims prior to submission. This process will help to minimize the potential for errors which result in claims being denied or delayed. Billing errors may be attributed to human error but they can be costly. Education regarding billing guidelines is available via many resources such as Internet Only Manuals (IOM) found on the CMS website, Local and National Coverage Determination policies and numerous newsletters, and training webinars/seminars. In this instance, lack of education can be more costly than the price of provider education.

Providers work hard to provide care to their patients. It is important to receive payment as quickly as possible in order to maintain the optimum financial health of your organization. Delays and denials in payment detract from that goal and if unresolved, can result in a loss or bad debt. To learn more about Revenue Cycle Management or Billing Compliance, This email address is being protected from spambots. You need JavaScript enabled to view it. about one of our upcoming webinars.