A pediatric therapy clinic needs a healthy cash flow in order to be sustainable. The revenue cycle affects nearly every area of a practice, from employee payroll to quality of care. Managing the revenue cycle may not be the most exciting part of running a clinic, but it serves as a foundation for everything you do. A well-managed revenue cycle will support a growing, thriving practice.
But let’s get practical. What does a well-managed revenue cycle actually look like? The answer depends on your individual practice and situation. What’s right for one clinic may not be right for another. In this post, we’ll explore three options for managing your revenue cycle, share the pros and cons of each, and give you tips on how to decide which is right for you.
What is the Healthcare Revenue Cycle?
First, let’s define what the revenue cycle is. The revenue cycle contains all the steps involved in being paid for the services you provide:
- Scheduling and preauthorization
- Providing care
- Submitting claims
- Managing rejections and denials
- Payment posting
- Reporting
If you neglect to streamline the process and address bottlenecks, a single issue in one step could have negative effects later on. For example, if your claims keep getting delayed due to mistakes, your payments will be delayed. It’s best practice to look at the revenue cycle as a whole and optimize how the steps are functioning both individually and together.
Now let’s dive into your options for management.
Managing the Revenue Cycle In-House
Managing your pediatric therapy clinic’s revenue cycle yourself (or designating and training an employee to manage it) can be a good choice.
Pros
The primary benefit of handling the revenue cycle internally is the cost savings. If you already have a staff member with experience in medical billing whose time isn’t being fully utilized, your additional costs for revenue management would essentially be nil.
You also have full control when handling the process internally. You know exactly what’s going on and have complete visibility into every part of your clinic’s financials.
Cons
On the negative side, medical billing is incredibly complex. The rules and best practices are continually changing, so whoever is handling the process will need to schedule time for ongoing education. If the staff member isn’t fully up to date, they may not be using the right codes to ensure full reimbursement for the services you provided, and they may make errors that cause rejections or denials.
If you’re using a good EMR, however, many of these drawbacks can be easily addressed. Your software should be able to auto-create claims based on your documentation, centralize and manage payers, and flag potential errors.
Check out our EMR Buyer’s Guide to learn what you should be looking for in an EMR to improve your practice’s claims submission process.
Considerations
If your staff is at capacity but you have low volume, hiring someone new to handle revenue management may not make sense. Something else to keep in mind is turnover rates. If you’ll need to be repeatedly training new people on the complexities of revenue management, in-house could be cumbersome.
Outsourcing Revenue Cycle Management
Handing the process off to a professional revenue cycle management company offers its own set of benefits and drawbacks.
Pros
When you outsource revenue management, you also outsource a lot of headaches. You no longer need to worry about keeping up with rules and best practices. You can focus on providing care and the parts of running a clinic that you enjoy.
Additionally, outsourcing to a good revenue management company should increase your revenue. You’ll ensure that you’re maximizing your reimbursements and not getting claims rejected due to errors. Cash flow should also improve.
Cons
The primary negatives of outsourcing are cost and risk. Outsourcing your revenue management can cost $3,500-$5,000 per month (or more, depending on your volume), so it can be a big financial commitment. You also need to do your due diligence to find a company you can trust to do a good job. Because you don’t have full control, you’ll lose some transparency.
Considerations
If your clinic is growing and you don’t have anyone on your team with experience in revenue management, you may want to consider outsourcing. Depending on the size of your practice and your history with revenue management, outsourcing may even pay for itself.
A Hybrid Model for Revenue Management: the Best of Both Worlds
A hybrid approach allows you to pull many of the positives from the other two models while mitigating the negatives. You can choose to handle the majority of the cycle in-house while outsourcing the process most likely to cause problems: billing.
Pros
With a good EMR, you can easily handle the least-complex processes in-house, allowing you to save money where you can. You’ll also have greater visibility than you would if you outsourced the whole cycle. Outsourcing the billing process will mean that you experience all the benefits that come with a professional team being dedicated to this aspect of your business. You’ll maximize reimbursements, improve cash flow, and allow your staff to focus on what they do best.
Cons
You’ll still need to vet the company you choose to outsource to. Search out their ratings, look at what their customers are saying, and ask the questions you need to in order to be confident that you’re making a smart choice.
Considerations
A hybrid model is ideal for many practices because it’s so flexible. You can outsource only the areas you’re weak in and continue managing the areas you excel in.
Keep in mind that whatever choice you make isn’t permanent. As your clinic grows and your situation changes, you can change the model you use for revenue management.
Need help with billing? Let us take care of your claims.
Spend less time on billing with Fusion’s claims management service. Schedule a call to find out if Assisted Billing is a good fit for your practice.
In-House Billing Kit
We’ve put together some resources to help you bring billing in-house. This In-House Billing Kit includes:
- A Verification Questionnaire to use when calling payers to verify coverage
- A 50% off coupon for our billing course, The Essentials of Insurance Billing for Therapy
- A Billing & Collections Checklist to guide you as you interact with caregivers
- A Payment Policy Generator to help you set expectations for caregivers
- 7 Tips to Help with Billing & Collections handout