Taking into account before receiving

Why This Topic Matters

It highlights how revenue cycle performance can be affected by actions taken before a patient visit, not just after claims are submitted. Understanding these workflow areas can help practices assess billing operations, reduce avoidable errors, and manage denials more effectively.

Article Sections

1. Centralized Scheduling Function

   Covers front-end scheduling and registration workflow considerations related to information capture, insurance verification, and access to payer resources.

2. Communication

   Discusses the importance of patient communication regarding payment policies and insurance-related expectations at the time of service.

3. Role of the Billing Manager

   Outlines general billing manager responsibilities related to monitoring industry changes, staying current with billing resources, and understanding payer mix.

4. The A/R Process

   Introduces the major components of an accounts receivable workflow, including reporting, benchmarks, internal review, audits, and denial handling.

5. Step 1 - Generating Aging Reports

   Describes the use of receivables reporting to monitor outstanding balances and review patterns across different categories.

6. Step 2 - Bench Marks

   Addresses the use of performance benchmarks to assess receivables trends and typical revenue cycle patterns.

7. Step 3 - Reviewing Claims Internally

   Covers internal claim review processes and tracking of recurring submission errors before claims move forward.

8. Step 4 - Routine Audits

   Discusses audit activities focused on claim accuracy, carrier rule awareness, and monitoring reimbursement patterns.

9. Step 5: Effective Denials Management

   Summarizes denial management as a key part of revenue cycle oversight and references common denial categories at a high level.