Advanced Revenue Cycle Analytics: An Overview

Privately owned physician practices continue to battle rising operating costs, declining reimbursement and increased complexity from government and commercial payers.  The MGMA benchmark is 2.7 billing staff per physician.  The three largest factors in revenue cycle productivity are: how charges are captured, the percentage of encounters that require coding corrections and revenue cycle workflow.  Most practices can operate more efficiently, which would reduce operating costs and improve profitability.

How are charges captured?

Most physician practices today use either their EHR to capture billing data or a paper superbill.  Practices that use their EHR for charge capture, typically have a higher percentage of encounters that require coding correction.  These practices have automated the charge capture and charge entry process, but fail to realize the promised ROI.   Staff time saved from automating charge entry time was simply reallocated to reviewing and correcting coding mistakes.

Many practices continue to use a paper superbill alongside their EHR, in an effort to protect physician productivity.  These practices continue to do manual charge entry into their PM system, where billing employees make coding corrections during the charge entry process.  These practices can typically handle between 20-30 encounters per hour per billing employee.

What percentage of encounters require coding review and correction?

Coding mistakes should be identified and corrected before encounters are posted to the PM system, regardless of the charge capture process.  The average practice makes coding corrections on 52% of all encounters.  Obviously, as this percentage of coding changes increases the encounters processed per hour decreases.

It is also important to consider the volume of encounters that revenue cycle staff review without making changes.  This process can consume considerable time that is often overlooked because there are no coding changes being made.  Practices with a large difference between the percentage of encounters reviewed and the percentage of encounters where coding changes are made have significant opportunities for increased throughput through workflow changes.

What is your Revenue Cycle Workflow?

Workflow optimization is critical to generating world-class revenue cycle outcomes.  White Plume client’s average 107 encounters per hour, while making coding corrections on 52% of all encounters.

The ideal workflow allows revenue cycle staff to review encounters on an exception only basis.  This means that they are able to focus their time dealing only with the encounters that have coding problems.  Providing the biller or coder with the encounter data and the potential coding problem on the same screen empower the billing team to process encounters at a very high speed and with incredible accuracy.