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and surgical precertifications when needed. Collect copays, coinsurance, deductibles, refraction fees, contact lens fees, and other fees for non-cov- ered services. Getting paid at the time of service helps eliminate col- lection problems and reduces ex- penses (staff time, auto statement fees, paper, toner, envelopes, and postage). Have a method for audit- ing charge capture. Adopt internal controls to ensure collections are handled appropriately. Don't forget to work the unapplied/unallocated balance and credit balance reports in addition to your aging. Reimbursement. Proper reim- bursement is achieved through best practices to ensure accurate pricing, charging, and coding for services re- lated to patient care. Manage the terms of your payer agreements and utilize the electronic practice man- agement system to track and review payment exceptions. Conduct a fee schedule audit to identify which CPT codes should be billed higher to capture the entire reimbursement per your contract. Avoid timely fil- ing adjustments and other unneces- sary write-offs by familiarizing yourself with payment and appeal guidelines. Compliance. A consistent elec- tronic practice management system provides the ability to manage and monitor CMS regulatory categories by bridging the gap between current regulations and those coded in the charge master and to routinely re- port on discrepancies. Proper use of ABNs is crucial. Revenue cycle mastery touches all points of care—from the moment of the initial appointment call to the final collection of payment—and oversights at any point hurt margins and compliance. EW EW Ophthalmology Business June 2011 63 Include account follow up in the revenue cycle mastery workflow. Maximize follow up by assessing bal- ances within different priority cate- gories (by payer, by plan, by age of account). Consider assignment within those categories. This pro- vides increased focus and a quantifi- able method of accountability within the department. Finally, it is important to moni- tor and measure against bench- marks. Create a spreadsheet showing revenue benchmarks that compares each month's A/R; compare month to month and prior year, and in- clude A/R days, denials, resubmis- sions, and days to resubmission. Once data is collated, drill down fur- ther to categorize denials by type and by biller to determine cause and identify training issues. Use the data to closely monitor trends and chal- lenges as well as set measurable and meaningful goals for the practice. Benchmarking internally supports organizational improvement and helps to develop systems and processes. When you benchmark ex- ternally (practice to practice, spe- cialty to specialty, region to region, best practices nationally), it not only supports improvement but also facil- itates knowledge, encourages search of other methods, fosters innova- tion, and convinces your staff of the need for improvement, which often initiates a positive change to behav- ior. Shrinking reimbursements are beyond our control. Most ophthal- mologists are already at volume ca- pacity and cannot work much harder to make up for decreasing in- come. Providers did not attend medical school to become billing ex- perts; however, we can no longer afford to delegate all of the responsi- bility to staff. Seek revenue cycle mastery by adjusting practice philos- ophy and fine-tuning practice processes. Summary points Operational efficiency. Technology allows people to work more effi- ciently by eliminating labor-inten- sive manual processes. Automated revenue tools are designed to iden- tify and address problems before they become patterns that drain rev- enue. Verify patient coverage and benefit eligibility. Obtain referrals ABOUT THE AUTHOR Ms. Morris has served in leadership roles with solo practices, multi-specialty groups, multi-location, hospital-based groups, and high volume refractive centers. She has 22 years of management experience with approximately 19 years concentrated in ophthalmology. She can be contacted at pat@4pmcoe1.com.

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