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Perfecting the Physician Revenue Cycle

Best Practices for Maximizing Professional Fee Collections

Topics: Physician Revenue Cycle, Revenue Cycle, Finance

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This study focuses on optimizing performance reporting and CBO organization, boosting front office performance, maximizing charge capture, and elevating payer management.

By reading this study, members will learn:

  • Key metrics to track across the physician revenue cycle enterprise
  • Strategies for increasing time-of-service collections
  • Best practices for improving physician documentation and charge capture
  • Methods for elevating payer management, including payer enrollment/credentialing, denials and underpayment tracking, and data-driven negotiations

Executive Summary

Stemming financial losses from employed physician practices

Health systems have dramatically increased the number of physicians they employ in an effort to lock in referral volumes, increase alignment around cost and quality objectives, and position their organizations to assume risk.

However, these strategic alignments have come at a significant cost: most employed physician practices operate at a loss, and cumulative losses for many systems are in the tens of millions of dollars. Given the numerous pressures on hospital margins, most health systems cannot sustain this level.

The revenue cycle opportunity

Finance leaders have a great ability to directly influence physician revenue cycle performance. The revenue cycle improvement opportunity for the typical employed physician organization is significant—easily reaching seven figures for medium to large groups. Yet, health system CFOs often struggle to identify approaches that effectively address the unique challenges of improving performance across a range of decentralized physician practices.

 Best practice physician revenue cycle operations share a common set of core attributes:

  • Dedicated leadership
  • Robust performance monitoring capabilities
  • Superior registration accuracy and time-of-service collections
  • Complete and accurate charge capture
  • Streamlined billing and denials management
  • Stringent payer contract management

Health systems that are executing across these imperatives are seeing dramatic improvement in financial performance of employed physicians.

Access the study for physician revenue cycle best practices

This volume examines critical aspects of physician revenue cycle management—ensuring adequate management infrastructure, hardwiring operational efficiencies, and maximizing revenue capture.

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