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The Revenue cycle is comprised of a front, middle and back end. Practice Managers need to optimize all three components for a practice to achieve an optimal collection rate. The front end of the revenue cycle is the front desk team in the practice. The front desk team members of a practice need to verify insurance eligibility as well as collect co-pays and any outstanding balances. Insurance eligibility can be verified via an automated link from the practice management system/clearing house to the insurance companies, Navinet or by calling the insurance companies. The owner as well as the practice manager of a practice need to insure that this activity is occurring accurately and consistently by the front desk team. The practice should check that the co-pay report for the day matches the co-pays collected. Also, the practice owner/manager should check-in with the back end billing team (billing company) to obtain feedback on the rate of accuracy of entering insurance and demographics by the front desk team. “Sloppy” work and/or lack of attention to detail by the front desk team can cause loss of revenue and/or delays in revenue.

The middle of the revenue cycle is comprised of the providers and clinical team properly documenting the charts as well as recording the diagnosis and CPT codes. This should be completed during the day of service and accurately. The back end of the revenue cycle is the billing team ‘scrubbing’ and verifying complete claims prior to sending to the insurance company. Additionally, the back end team will re-submit claims (make appropriate corrections) as well as send out patient statements and communicate to the front desk team for patients that have balances. The front desk team needs to effectively work with the back-end billing team to close the communication gap. When the front, middle and back-end of the revenue cycle is optimized due to good practice management, practices achieve better collection rates and faster payments than the average. For instance, we have practices that are 50% paid by the insurance company five days after the month closes (e.g. July is 50% paid for all insurance charges by August 5th).

Each member of the team needs to understand their role in the revenue cycle. Practice Managers as well as physician partners should be monitoring performance of the front desk team, the providers as well as the work of the back end billing team. Collaboration and cooperation as well as a skilled and dedicated team are critical to achieving the best success.

All practices have accounts receivables. There is a wide distribution of how efficiently Pediatric practices manage the revenue cycle to minimize the amount of revenue in accounts receivable. A common measure in the industry for benchmarking how well a practice manages the revenue cycle is Accounts Receivable Days or more commonly known as AR Days. What are AR days? Let’s look at an example. If a practice has an average of $100,000 in gross charges a month and currently has $200,000 in accounts receivable (waiting to be paid by insurance companies and patients), the practice has approximately 60 AR Days. All practices should continue to optimize their processes and systems until the practice consistently operates at less than 30 AR days.

There are many inefficiencies that slow down the revenue cycle for practices. For instance, some practices leave a copy of all their charges each week for a biller to ‘pick up’ then send to the insurance company. The biller/billing company then needs to enter these charges in their system, review and send to the clearing house. In some cases, at least two weeks pass prior to the claim being uploaded to the insurance company. I am aware of some hospital systems that wait to the end of the month to send all claims – what a wasteful practice! A strong Pediatric Billing company measures, monitors and benchmarks these processes and looks for ways to improve the AR days for the practice. This usually requires best practice sharing and routine evaluation of pain points in the revenue cycle. This is difficult for an average biller of a practice to do successfully due to their time and focus need to focus on the daily management of claims. Pediatric practices are dependent on the practices systems, processes and back-end billing team to minimize the AR days for the practice.