Orthopedic Practice Accounts Receivable Management

Managing a revenue cycle, especially in the medical field, is no easy task. Here are some of Dave D’Silva’s recommendations for monitoring the health of the revenue cycle.

  • Employ a series of management reports to be looked at on a daily basis.
  • Examine not only the number of claims, but dollar values as well to check for any abnormalities.
  • We look at the trends of positive information as well as rejected claim information that comes in on a daily basis.
  • If you are only tracking volume, rather than trends then you are missing more than half of the key elements of information. You must understand the trends of why claims are being rejected.
  • When you look at your billing patterns, they should essentially be flat. In other words, there should not be inconsistencies with the dollar volume of charges being posted on a daily basis. It should be a flat line.
  • There is a direct correlation between your collections and your billing patterns, so it’s essential to work with your physicians. There is a consistency in the timeliness of charges being turned in, entered both “office” and “surgical” charges.
  • Pay close attention to the trending number of days outstanding. What’s the turnaround? MGMA benchmark is 36. Again, that will vary depending on your payer mix, but benchmarks and averages are helpful.

Look at the number of dollars and the percentages in the 120 and over bucket. MGMA’s benchmark is 14%. This is a reasonable goal to achieve. By checking on a monthly basis, you’re in a better position to act quickly when you see the percentage in a 120-bucket go from 13% to 17%. A red flag goes off and you’re talking to your billing managers or supervisors.