By: Christi Arnett
Healthcare providers should have a year-end checklist to review current billing processes, as areas of weakness can lead to poor performance that may affect the new year. Weak RCM processes can lead to unbilled claims which affect revenue. A busy schedule, or a lack of expertise in this area often leads to these checks and balances going undone. That’s why we are sharing the 7 steps to take before the end of the year to ensure you’re ready to take control of your revenue in 2025.
1. Review AR for unbilled claims
Your accounts receivables should be reviewed on a monthly basis in order to verify that all claims have been submitted for processing. Doing another review at the end of the year can help identify any claims that may have been missed leading to write offs due to timely denials. All claims should be submitted in a timely manner. Claims should always be reviewed when they have been sitting for longer than 90 days with no activity.
2. Identify payments that have not been posted into your PM system
Some claims may have been paid but not posted back into the PM system. Review for outstanding insurance balances to determine if payment was received but not resolved in the practice software. Cleaning up balances can help make sure all claims are finalized.
3. Review patient AR
Practices should send out patient statements in a timely manner. However, when claims are not finalized, some patient balances may have been missed. Review outstanding receivables to ensure that all patient responsibilities were collected appropriately.
4. Set goals for the new year
Set goals and KPIs that can set the practice up for success. Discuss with your team members what needs work or improvement in order to achieve these goals.
5. Ensure compliance checks
Make sure that annual compliance training has been completed by all team members. If it’s been more than a year, it might be time to perform an overall risk assessment for your practice as well.
6. Review practice expenditures
It’s important to review all practice expenditures at the end of each year. This will help you to identify areas leaking revenue and see where money could be saved or better utilized. Some common areas to review include missed patient collections, credentialing issues, unresolved claim denials, and payer underpayments.
7. Annual medical record audit
Conducting a yearly audit of medical records is an excellent way to ensure that your practice isn’t missing out on potential revenue. An audit can help identify charting errors and highlight areas for improvement. Additionally, audits ensure compliance with regulations and help prevent fraudulent claim activity. It can also reveal whether CPT codes are being used correctly or if there are opportunities for increased revenue.
Help set your practice up for success by ensuring that your revenue cycle follows best practices. If there are any areas of weakness, take the time to implement improved processes to ensure financial success. If you’re short on time, or aren’t sure where to start, OMS can help you assess and review your processes to make a game plan for future success.