Every week, I speak with Program Directors (PDs) to discuss revenue cycle. They tell me their primary concern is patient satisfaction, clinician issues, and scheduling - as it should be. But when I ask when they last reviewed their department’s accounts receivables, I often get a puzzled look or an “I can’t remember.”
Every department director should review their A/R on a weekly basis. Of course, as a PD for a wound care and hyperbaric oxygen medicine program, it’s not necessary to take the same razor-focused approach that someone in Patient Financial Services (PFS) would take, however, there should be some engagement with the numbers to stay on top of on what keeps the program operating efficiently. It’s just good business. PFS departments are involved with resolutions, and they focus on high dollars. They don’t always have the time or personnel to research denials and their root causes.
Some PDs have told me they do not receive or review any A/R reports for their department - whether it’s a month-over-month collection report, list of denials, or even a snapshot. Your CFO could reach out to you at any time to ask why the department is not paying for itself, and they will expect YOU to be able to dig in and find out. It’s best to be proactive and approach your A/R by wearing both a program director and revenue cycle hat.
It’s important for every PD to educate themselves on how to properly review their A/R. For starters, this will require engaging with PFS and requesting a daily report. Even if you don’t review it every day, you need to set aside time to review the reports weekly, at the very least. The reports should provide demographic information, payments, denial reasons, bill dates, balances, and zero payment (or denial reasons, if they are posted).
As a PD, you may ask: “Once I have the report, what do I do with it?” Again, the idea is to familiarize yourself with the process. Review the report, identify problem trends, resolve, and repair issues. By getting into the habit of a weekly review, you’ll learn how to identify denials and start the process of reviewing “root causes” (i.e., who or what caused the denial). Root cause identification will allow you to begin the process of remedying any issues your department is facing. For example, identifying “registration entering incorrect data” signals that your registration staff may be making errors in entering patient data, which is causing denials.
As an added bonus, your newly focused attention to A/R may help you uncover opportunities to increase revenue. Is your registration staff requesting co-pays at the time of service, or do they let the insurance do the work? Are your physicians signing documentation in a timely manner? If documentation is not signed off, it cannot be coded, and it will not be billed. Are physicians responding to coding queries? Creating and adopting these simple policies will increase your department cash flow and assist in keeping days in A/R down. Give it a try!