Is Your Financial Health Where You Want It to Be?

It’s hard to step back and look at the big picture when you’re running a clinic; the day-to-day takes up so much time and energy that long-term strategy and planning feel like a luxury.  The catch is that getting out of that daily grind, building something that’s sustainable and that operates on rails, requires thinking beyond the next patient, the next day, or the next payroll. 

You probably have a sense of your practice’s revenue and financial performance when you look at your bank account, but do you have a picture of larger trends, possible problems, and areas of potential growth? You’re noticing the bottlenecks that pop up in your workflows, but do you know what the root causes are? To get ahead, you need to slow down, step back, and assess what’s working and what isn’t.  

It’s time for that annual checkup. 

Most of us get our physical health assessed once a year to avoid big, painful, and expensive problems, yet when it comes to financial health, clinic owners and leaders aren’t taking the same approach.  They take the same tack as those who skip those yearly checkups, thinking that ignorance is the same as avoiding the problem. 

Like health issues, revenue cycle problems aren’t going to go away or solve themselves, and left unchecked over time, they can compound into something much worse. An annual revenue review can help clinics identify issues and create a plan to correct them over time to build better long-term financial health.    

Start off with clean claims performance.

A bellwether of your practice’s financial health is your clean claims, or lack thereof, depending on your analysis. Producing clean claims consistently tells you that your upstream processes at the front desk are effective, producing correct intake information as well as checking and tracking authorizations and eligibility. It's also a sign that your documentation is strong and that your billing team is doing the work to scrub claims before they’re submitted. 

If you’re seeing a lower-than-average rate of clean claims, it’s time to ask questions about your processes, like: 

• What are the most common rejection or denial reasons you’re seeing?
• Are the same issues repeating month after month?

Some digging should help reveal what’s causing the problem, whether it’s an issue in one area of the workflow or more systemic. 

Review your denial trends by payer.

Denials are another area where you can take the temperature of your larger revenue operation. The number of denials you’re seeing is a fairly legible indicator of how well you’re doing with the aforementioned clean claims, but the trends within the denials themselves can tell a story.  

Breaking down denials by payer and denial code will point to the specific issues that might be leading to claims being sent back, whether it’s a problem with unauthorized visits, documentation that isn’t meeting payer standards for the affixed coding, an issue with submitting claims on time, or one of many payer peculiarities that can get claims caught up. 

Make sure your documentation is up to standard. 

Payers are apt to deny claims for documentation that doesn’t match their defined standards. Each payer may differ to some degree in what they’re asking for, but in short, your claims need to make the case for why that patient needed skilled intervention from one of your clinicians. More than that, though, it needs to be submitted within the prescribed timeframe set by the payer. 

Complete and defensible documentation is certainly its own challenge, but the simple fix is to ensure that your claims are at least submitted on time. If you’re frequently running into delays that lead to denials, rework, and appeals, you need to examine where your processes are breaking down.  Are notes regularly completed within the expected timeframe? Are progress reports submitted on time? Is your billing team scrambling to get claims out at the last minute? All of those issues lead to delayed revenue.        

Evaluate your front office workflows. 

Your financial health starts at your front desk, alongside your patients and their treatment journey. Eligibility checks and authorization management at the start set the stage for a smooth experience for both your practice and the patient, and communication and collections along the way help ensure that your A/R isn’t adding up. If you’re uncovering revenue problems that start at the front desk, it’s likely a sign of issues in your intake, scheduling, and collections workflows.   

Take a look at your aging A/R and follow-up process. 

Your A/R tells the story of revenue cycle processes; if your past-due claims are trending up, you’re not performing as well as you should with both clean claims and your follow-up.  Take a look at where your A/R is trending, where those claims are concentrated, and whether you’re correctly prioritizing your follow-up efforts to make the most impact.   

Assess the strain on your staff.

More than any other factor, your revenue cycle and financial health depend on people. You need a team that’s not only capable and well-trained but also focused and in the right frame of mind. The lingering burnout issue in rehab therapy is a constant challenge to your clinical and administrative effectiveness; mistakes creep in when your team is tired and overworked, and problems only get worse if they’re leaving your clinic for a less-stressful job. 

In examining your processes, think about where you can make improvements to reduce manual work and strain, with an eye towards the most repetitive, time-consuming tasks and those requiring the most manual effort. Technology and automation as part of your processes can cut down on that repetitive work and reduce the number of mistakes that can crop up from human error.   

Identify a handful of high-impact fixes.

It’s tough to make major changes overnight, even in a smaller clinic. If you’re looking for significant improvement in the immediate term, look to smaller adjustments that can make an outsized impact, like:

• Tightening benefits verification and authorization tracking processes
• Emphasizing documentation standards across the practice 
• Identifying and reducing repeat denial root causes
• Improving handoffs from front office to billing 

Consider adding help. 

Many practices are going the route of partnering with a trusted billing team to rid themselves of revenue cycle headaches entirely.  

WebPT’s RCM services will handle the entire billing process for you, speeding up the time from claims submission to payment and increasing the predictability of your practice’s revenue. See how you can boost your revenue with a trusted billing partner.