A Billing Assessment, also called a Revenue Cycle Assessment, is important for any organization, whether small or large, because there are many “red flag areas” that can potentially reduce cash flow, present compliance risks, and impact efficiencies.

What’s Involved in a Billing Assessment?

From patient demographics, insurance verification, charge entry, coding, electronic claims submission, payment posting, denial management, AR follow-up, revenue recognition, to fee schedule setup and more…. Revenue Cycle Consultants analyze the front-end to back-end review of the health of your Revenue Cycle, including: [bullets]

Zero balance claim audits are one of the keys to the Billing Assessment. Auditing zero balances allows us to review charge entry, payments, and adjustments. We often find claims improperly adjusted, payments not made according to fee schedules, denials not worked, and much more during this part of the Billing Assessment. It will also reveal issues with timeliness of claims submission, accuracy of payment posting and thoroughness of AR follow-up. Below are several key questions asked during the assessment.

• Was insurance verified prior to the appointment typically within at least 48 hours prior?
• If eligibility was expired at the time of appointment, was a follow-up call made to the patient prior to their visit?
• Were the patient demographics entered accurately into the practice management system?
• Was the copay or coinsurance estimate collected at the time of service?
• Was the claim filed within 24-48 hours of the patient’s date of service?
• Did the claim pay upon first claims submission or at “first pass”?
• If the claim denied, was the denial worked and in a timely fashion?
• Were all system claim edits or rejections worked within 48 hours of notification?
• Do all procedure codes on the claim match the clinical documentation?
• Were all Insurance and Patient Payments posted correctly?
• Were outstanding insurance accounts receivable followed up on timely?
• Are key metrics or key performance indicators reviewed by management to identify potential areas of concern or trends?

Typical Findings of a Billing Assessment

The scope of the assessment varies based on the feedback we receive during initial conversations with each client. Initial standard reporting is generated and reviewed for indicators of problem areas.   We typically find issues like those listed below during an Assessment.

• Billing submission delays
• Edits and rejections not worked or corrected
• Procedure and Diagnosis Coding issues
• Incomplete documentation
• Denial trends that management was unaware of
• Claims adjusted that could have been worked and paid
• Fee schedule inaccuracies
• Inefficient or broken processes
• Credentialing delays
• Gaps in training and accountability

The bottom line: we most often find revenue “being left on the table” due to lack of knowledge, training, and accountability. It is encouraging to find areas of improvement that will yield increased cash collections for any practice or organization.

In addition, during an assessment, Revenue Cycle Consultants will document all findings and make recommendations for future state workflow and process changes.

How will our findings improve the Revenue Cycle?

During the Billing Assessment, a gap analysis helps us determine whether issues in your office’s workflow exist that could delay cash or lead to billing errors. The Assessment will reveal where there are opportunities to improve processes, increase cash flow, implement accountability tools and more.  Our goal is to collaborate with you and your team to prioritize and improve the critical areas impacting patient satisfaction and quality as well as cash flow and compliance.

Has a Billing Assessment or Revenue Cycle Assessment for your practice within the past year? An annual Assessment could be the difference in success and profitability of your group. It is worth the time and money to repair the revenue cycle today! Reach out to Legacy Consulting Services via the Contact Us Form or you can email us at admin@legacyconsultingservices.com.