Is Your Revenue Cycle Leaking Money Out of Your Practice?
IN BRIEF
Mike Carberry
DC
With the latest changes in government regulations, chiropractic and medically integrated practices have to pay closer attention to how they collect payments from third-party health insurance companies. These third-party companies have negotiated fee-for-service contracts with providers that are resulting in lower, and in some cases, zero, reimbursements for those offices.
The Healthcare Insurance Portability & Accountability Act (HIPAA) is also restricting the requirements for the claim data submissions that chiropractic and medically integrated offices depend on. Before this modification, the practices had limited access to third-party payers with an added layer of scrutiny. As chiropractic practices are incorporating more and more into the medically integrated model, they will have to modify the way their care services are billed.
Because of the updates to HIPAA and administrative law, practice owners need to place an emphasis on having a healthy revenue cycle with their patients now more than ever.
But what is the revenue cycle? In relation to a private medically integrated office, this term is described as the entire life of a patient account, from creation to payment. The revenue cycle includes all administrative and clinical functions that advance the capture, management and collection of patient service revenue.
For a chiropractic office that has newly transitioned into a medically integrated practice, this may be something new that needs to be expanded.
The last thing a medically integrated practice needs is to go unpaid for a provided service. To prevent this, practice owners should implement a set of best practices to establish a healthy and predictable revenue cycle.
There are several simple actions that can help create that stability. For example, take notes on following proper billing and collection procedures to ensure that money is properly collected for cash-services. Also, ensure bills are submitted in accordance with payor requirements and make sure all services provided are billed and/or collected in a timely manner.
By confirming you and your staff have properly followed your office’s best practices during a patient’s revenue cycle, you are able to avoid what’s known as revenue cycle “leakage points”. There are many different leakage points during this time, however, the most common include:
1. Not collecting for cash-only services at the time of service
2. Registration, coding or billing errors for expanded services
3. Unverified insurance
4. Underpaid and denied claims
5. Denied appeals
To greatly minimize and even prevent these leakage points, it is best to implement the right systems. With the right consulting group, such as Advanced Medical Integration, you can navigate the revenue cycle with confidence. Installing the proper policies and procedures is the protection you need for preventing your medically integrated practice from losing money.
Mike Carberry, DC, is a Stockton University graduate and author of "The Death of American Healthcare". He speaks nationally on an array of topics ranging from business, economics, and functional medicine's role in fighting the opioid crisis. Co-founder of Advanced Medical Integration, his mission is to end the opioid crisis. AMI is offering live virtual events. To sign up visit: amidoctors.com.
