As a consultant in physician network management, I regularly recommend that healthcare systems contract with an external expert to perform quarterly audits on coding and revenue cycle metrics for their providers.
Because if you’re not monitoring metrics, you’re leaving money on the table. And not just a few hundred dollars.
One example of a revealing metric is the adjusted fee-for-service collection percentage. When we find that a client has not been monitoring this metric, we perform the calculation and often discover that they are leaving hundreds of thousands of dollars on the table.
Audits shine a light on these neglected areas of potential revenue—which are abundant, particularly if you haven’t been reviewing revenue cycle metrics on a routine basis. But that’s not the only benefit. They also highlight challenges or deficiencies in other areas of operation, such as governance, compliance, processes, and staff training and education.
When you’re reviewing provider coding regularly, the coding aspect of the revenue cycle stays top of mind, and your organization is more likely to provide the necessary coding education and support for physicians and other staff members in order to capture charges accurately, optimize coding, and reduce denials, ultimately leading to an increase in revenue.
Coding and revenue cycle audits are an industry best practice, and hardwiring the audit process with an external firm provides an unbiased way to monitor the health of the physician network. In today’s fast-paced industry, where administrators are juggling competing priorities and responding to multiple industry changes, it is hard to keep everything in focus. A quarterly mini audit of key metrics is a low-cost way to add tremendous value and to bring revenue cycle best practices to the forefront.
After years in healthcare, I’m still amazed that you can learn so much about a physician network by reviewing key revenue cycle metrics. Remember, the greatest opportunity for network optimization might just be submerged in your data!
Are you leaving money on the table? Click here for our complimentary Adjusted FFS Collection Percentage Assessment.