Revenue Sources – Part 1: Patient Revenue

 In Articles, Coding & Documentation, Provider Notes

Rocking Your Revenue Cycle

A master series on maximizing Excel

Practices and providers are facing many challenges regarding reimbursement for services; ICD10, PQRS penalties, and the Sustainable Growth Rate calculation come to mind. In this series, we will show you some basic tools using Excel to keep a finger on the pulse of your revenue cycle.

Revenue Sources – Part 1

Patient Revenue – (Estimator Tool)

Have you ever wondered why healthcare services are paid after the services are provided? If you have a good answer to this, MSOC Health would like to know.

All kidding aside, in our first segment, we will focus on revenue sources and how to track and analyze those sources using the Patient Estimator tool. All you need is your volume data and your carrier contracts to answer the most pertinent questions about your revenue sources, such as …

Am I maximizing patient collections?

The importance of time-of-service collections cannot be overstated. The healthcare industry is changing rapidly, becoming more consumer-driven than ever before. The impact of new laws and regulations has seen a sharp rise in Healthcare Spending Accounts and high-deductible plans; responsibility for covering treatment costs has shifted even more towards patients. What does this mean for your practice? The key is to place collection priority on the front end and ensure that you are taking in as much of a patient’s responsibility as possible before the patient leaves the office.

The biggest barrier to up front collections has always been determining how much to collect from each patient. With copies of your fee schedules or contracts, you can use Excel to quickly and easily estimate the patient’s responsibility for any combination of services.

Here’s how it works:

1. Input your fee schedules into Excel side-by-side. You’ll need CPT-level data at the very least; provider (physician or mid-level) and facility differentials, if available, will make the final estimate more accurate.

Am I maximizing patient collections?

2. Input the patient’s benefits (copay, coinsurance, and remaining deductible).

3. Input the specific set of services encompassing the patient’s visit (CPT/HCPCS codes and quantities).

4. Use Excel formulas to cross-reference the carrier, provider, and location allowables for the services against your contracted rates and calculate the patient’s portion of the allowable based on their benefits.

Am I maximizing patient collections?

Implementing a patient responsibility estimator tool in your practice may require workflow changes. Visits need to be coded at least to CPT level before the patient leaves, and the check-out process should incorporate estimating and collecting payment for services rendered. Don’t be afraid to take the plunge! Case studies have shown an increase of 2-4% in revenue collected at time-of-service after implementation.

If you have questions or would like assistance in creating a patient estimator tool and implementing it in your practice, please contact us, and stay tuned for Part II in our series, Rocking Your Revenue Cycle: Revenue Sources.

Recommended Posts

Start typing and press Enter to search