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Date ArticleType
4/2/2018 Payment/Reimbursement
MEMBER SPOTLIGHT: Is your revenue cycle process optimized to collect appropriate reimbursement?

The article below is part of the IHCA/INCAL Member Spotlight series. We greatly appreciate the generous support of our Title members and Key members and deeply value their expertise. Beginning April 2018, we will be spotlighting our Title members and Key members and will feature their insights on important topics and issues that impact our sector. Look out for these informative posts in our newsletter and IHCA-owned digital and social media communication platforms. 


By Jeff Heaphy

The growth of managed care organizations in the post-acute provider world has significantly increased complexity for the revenue cycle process. Each plan has its unique contractual requirements starting at pre-admission through claim processing. In order to achieve timely and accurate payments, providers must utilize a comprehensive approach that entails much more than billing. Don’t allow your organization to suffer from unnecessary claims adjustments, bad debts, and lost revenue.

Does your organization show any of these warning signs?

  • Increasing accounts receivable (A/R) balance
  • Increase in accounts receivable over 120 days
  • Increase in days in A/R
  • Decrease in cash
  • Increase in bad debt expense
  • Swings in revenue not attributed to census
  • Unexplained variances in contractual allowance accounts
  • Lack of accountability for uncollected balances
  • Loan covenant violations
  • Increase in post-payment claims reviews

If you recognize any of the warning signs, it is time to evaluate your entire revenue cycle management process, including: pre-admission activities, prior authorization for services, clinical interfaces, claim billing, triple check process, follow-up and post-payment reviews.

Your comprehensive review should consider the following areas:

People – the degree to which staff are knowledgeable and compliant of payor policies, processes, and procedures.

Process – the sequence and flow of steps and activities performed from pre-admission to claim submission to achieve payment.

Technology – the extent to which technology supports processes and promote efficiency.

If you see any warning signs in your processes or have any questions, please contact Jeff Heaphy at jeff.heaphy@plantemoran.com or 614-222-9035.