United States: Giving Your Revenue Cycle An Annual Checkup

Last Updated: June 1 2016
Article by Greg Koelling, CPA

The financial side of the practice appears to be running smoothly. Claims are submitted timely and paid relatively quickly. However, no one really knows whether the revenue cycle management system is functioning at its peak potential. In such cases, a checkup of the practice's system may be advisable.

Is Your Performance in High Gear?

A good way to approach a system review is to first schedule out the steps in your existing system, noting areas where you believe processes are working well and where improvements can be made. Next, compare your processes to the components of a top-class system to see if changes make sense for your practice. This analysis should be done at least once a year to assess your practice's strengths and weaknesses in the various functional areas of the revenue cycle.

For example, many practices struggle with patient collections. Ask yourself questions such as: Does the practice determine patient eligibility consistently and accurately? Does it collect from patients all appropriate co-payments, deductibles and overdue balances? To accomplish these tasks, the practice must have clear staff policies that are uniformly enforced.

Are You Maximizing Revenues?

The goal of the coding process is to maximize revenues without committing compliance violations. Close communication between the doctors performing the medical services and the staff assigning codes to them is required to achieve this goal. Does your practice know how well the physicians and coding staff interact?

When your practice learns that a claim has been denied or that a payer has taken adverse action, you must take corrective measures to reverse the denial and prevent similar issues in the future. Does the practice have a systematic appeals procedure that is triggered automatically and addresses the denial problem effectively?

One of the most effective ways to prevent claim denial is through up-front, electronic verification and monitoring. Most payers allow for prior authorization, claim submission, status inquiry and verification of eligibility and benefits by electronic means. Additionally, most are enabled for electronic payment and remittance, which speeds the receipt of claims. Every practice should work to take advantage of these opportunities to increase accuracy and productivity while reducing costs.

How is Your Overall Performance?

In a modern medical practice, business performance is measured with precision by gathering and analyzing the right kinds of data. Analyzing your practice's metrics will point to the causes of both problems and successes.

To keep revenue cycle functions operating at peak effectiveness, it is essential to gather data, summarize the information and analyze the performance. For the practice as a whole, these data points are critical:

  • Gross and net collection percentage;
  • Accounts receivable (days over 90 days);
  • Collections percentage by payer;
  • The percentage of co-payments collected at time of visit;
  • Number and percentage of patients with accounts receivable balances;
  • How quickly visits/procedures are billed;
  • Average days between claim submission and payer reimbursement;
  • Percentage of insurance eligibility verifications vs. total scheduled patients;
  • Average number of missing charges vs. services rendered (actual and CPT mistakes);
  • Percentage of denials vs. total claims filed;
  • Percentage of denials appealed successfully vs. total denials; and
  • Average days between receipt of payment and payment posted.

This information should be reported on a monthly basis using a simple dashboard format. This will allow problems to be identified and corrective action taken in a timely manner.

Do You Have a Culture of Success?

Successful management of the revenue cycle also depends on fostering a culture of respect and awareness of the practice's finances. If you are able to change both employees' and physicians' mentalities to understand that their actions affect the practice's financial position and incentivize them to act appropriately, the practice will thrive.

Each individual will understand that their role contributes to the common financial purpose of the practice. They will envision a single, integrated system that serves patients, collects compensation and efficiently manages revenue and they will understand that they will be rewarded for this performance.

Are You Ready?

Ultimately, a strong revenue cycle depends on practice leadership that's ready and willing to continually evaluate its performance, candidly acknowledge problems and take bold steps to eliminate them.

Sidebar: Ensure Your Providers Abide by Their Contracts

Payers make regular changes to their contracts with providers. Some are significant, others more superficial — however, every revision has the potential to impact your practice. Whenever a contract change occurs, study it carefully and project how the alteration will affect your operations. In some cases, you may need to adjust your processes.

Of course, your payers also have obligations under their contracts ― the most important of which is the reimbursement schedule. Yet, payers have been known to stray from that schedule to the provider's disadvantage. To protect your revenue cycle, maintain a constant awareness of your contracts' payment terms, track the accuracy of payments you receive and challenge any payer that violates its terms.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

Greg Koelling, CPA
In association with
Related Topics
Related Articles
Related Video
Up-coming Events Search
Font Size:
Mondaq on Twitter
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).
Email Address
Company Name
Confirm Password
Mondaq Topics -- Select your Interests
 Law Performance
 Law Practice
 Media & IT
 Real Estate
 Wealth Mgt
Asia Pacific
European Union
Latin America
Middle East
United States
Worldwide Updates
Registration (you must scroll down to set your data preferences)

Mondaq Ltd requires you to register and provide information that personally identifies you, including your content preferences, for three primary purposes (full details of Mondaq’s use of your personal data can be found in our Privacy and Cookies Notice):

  • To allow you to personalize the Mondaq websites you are visiting to show content ("Content") relevant to your interests.
  • To enable features such as password reminder, news alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our content providers ("Contributors") who contribute Content for free for your use.

Mondaq hopes that our registered users will support us in maintaining our free to view business model by consenting to our use of your personal data as described below.

Mondaq has a "free to view" business model. Our services are paid for by Contributors in exchange for Mondaq providing them with access to information about who accesses their content. Once personal data is transferred to our Contributors they become a data controller of this personal data. They use it to measure the response that their articles are receiving, as a form of market research. They may also use it to provide Mondaq users with information about their products and services.

Details of each Contributor to which your personal data will be transferred is clearly stated within the Content that you access. For full details of how this Contributor will use your personal data, you should review the Contributor’s own Privacy Notice.

Please indicate your preference below:

Yes, I am happy to support Mondaq in maintaining its free to view business model by agreeing to allow Mondaq to share my personal data with Contributors whose Content I access
No, I do not want Mondaq to share my personal data with Contributors

Also please let us know whether you are happy to receive communications promoting products and services offered by Mondaq:

Yes, I am happy to received promotional communications from Mondaq
No, please do not send me promotional communications from Mondaq
Terms & Conditions

Mondaq.com (the Website) is owned and managed by Mondaq Ltd (Mondaq). Mondaq grants you a non-exclusive, revocable licence to access the Website and associated services, such as the Mondaq News Alerts (Services), subject to and in consideration of your compliance with the following terms and conditions of use (Terms). Your use of the Website and/or Services constitutes your agreement to the Terms. Mondaq may terminate your use of the Website and Services if you are in breach of these Terms or if Mondaq decides to terminate the licence granted hereunder for any reason whatsoever.

Use of www.mondaq.com

To Use Mondaq.com you must be: eighteen (18) years old or over; legally capable of entering into binding contracts; and not in any way prohibited by the applicable law to enter into these Terms in the jurisdiction which you are currently located.

You may use the Website as an unregistered user, however, you are required to register as a user if you wish to read the full text of the Content or to receive the Services.

You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these Terms or with the prior written consent of Mondaq. You may not use electronic or other means to extract details or information from the Content. Nor shall you extract information about users or Contributors in order to offer them any services or products.

In your use of the Website and/or Services you shall: comply with all applicable laws, regulations, directives and legislations which apply to your Use of the Website and/or Services in whatever country you are physically located including without limitation any and all consumer law, export control laws and regulations; provide to us true, correct and accurate information and promptly inform us in the event that any information that you have provided to us changes or becomes inaccurate; notify Mondaq immediately of any circumstances where you have reason to believe that any Intellectual Property Rights or any other rights of any third party may have been infringed; co-operate with reasonable security or other checks or requests for information made by Mondaq from time to time; and at all times be fully liable for the breach of any of these Terms by a third party using your login details to access the Website and/or Services

however, you shall not: do anything likely to impair, interfere with or damage or cause harm or distress to any persons, or the network; do anything that will infringe any Intellectual Property Rights or other rights of Mondaq or any third party; or use the Website, Services and/or Content otherwise than in accordance with these Terms; use any trade marks or service marks of Mondaq or the Contributors, or do anything which may be seen to take unfair advantage of the reputation and goodwill of Mondaq or the Contributors, or the Website, Services and/or Content.

Mondaq reserves the right, in its sole discretion, to take any action that it deems necessary and appropriate in the event it considers that there is a breach or threatened breach of the Terms.

Mondaq’s Rights and Obligations

Unless otherwise expressly set out to the contrary, nothing in these Terms shall serve to transfer from Mondaq to you, any Intellectual Property Rights owned by and/or licensed to Mondaq and all rights, title and interest in and to such Intellectual Property Rights will remain exclusively with Mondaq and/or its licensors.

Mondaq shall use its reasonable endeavours to make the Website and Services available to you at all times, but we cannot guarantee an uninterrupted and fault free service.

Mondaq reserves the right to make changes to the services and/or the Website or part thereof, from time to time, and we may add, remove, modify and/or vary any elements of features and functionalities of the Website or the services.

Mondaq also reserves the right from time to time to monitor your Use of the Website and/or services.


The Content is general information only. It is not intended to constitute legal advice or seek to be the complete and comprehensive statement of the law, nor is it intended to address your specific requirements or provide advice on which reliance should be placed. Mondaq and/or its Contributors and other suppliers make no representations about the suitability of the information contained in the Content for any purpose. All Content provided "as is" without warranty of any kind. Mondaq and/or its Contributors and other suppliers hereby exclude and disclaim all representations, warranties or guarantees with regard to the Content, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. To the maximum extent permitted by law, Mondaq expressly excludes all representations, warranties, obligations, and liabilities arising out of or in connection with all Content. In no event shall Mondaq and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use of the Content or performance of Mondaq’s Services.


Mondaq may alter or amend these Terms by amending them on the Website. By continuing to Use the Services and/or the Website after such amendment, you will be deemed to have accepted any amendment to these Terms.

These Terms shall be governed by and construed in accordance with the laws of England and Wales and you irrevocably submit to the exclusive jurisdiction of the courts of England and Wales to settle any dispute which may arise out of or in connection with these Terms. If you live outside the United Kingdom, English law shall apply only to the extent that English law shall not deprive you of any legal protection accorded in accordance with the law of the place where you are habitually resident ("Local Law"). In the event English law deprives you of any legal protection which is accorded to you under Local Law, then these terms shall be governed by Local Law and any dispute or claim arising out of or in connection with these Terms shall be subject to the non-exclusive jurisdiction of the courts where you are habitually resident.

You may print and keep a copy of these Terms, which form the entire agreement between you and Mondaq and supersede any other communications or advertising in respect of the Service and/or the Website.

No delay in exercising or non-exercise by you and/or Mondaq of any of its rights under or in connection with these Terms shall operate as a waiver or release of each of your or Mondaq’s right. Rather, any such waiver or release must be specifically granted in writing signed by the party granting it.

If any part of these Terms is held unenforceable, that part shall be enforced to the maximum extent permissible so as to give effect to the intent of the parties, and the Terms shall continue in full force and effect.

Mondaq shall not incur any liability to you on account of any loss or damage resulting from any delay or failure to perform all or any part of these Terms if such delay or failure is caused, in whole or in part, by events, occurrences, or causes beyond the control of Mondaq. Such events, occurrences or causes will include, without limitation, acts of God, strikes, lockouts, server and network failure, riots, acts of war, earthquakes, fire and explosions.

By clicking Register you state you have read and agree to our Terms and Conditions