Medical Office Revenue Cycle Assessment

The Challenge

A large physicians’ practice was experiencing significant declines in operational performance after many years of profit and success. The physicians were not able to isolate the issues causing the problems, but felt like they were working harder than ever to make less money than in the past. The client inquired as to whether GBQ could perform a “check-up” on the office operations.

The Solution

GBQ performed an in-depth practice assessment, which included a comprehensive review of the revenue cycle, and all billing and accounts receivable processes. GBQ discovered that the administrative processes were insufficient to properly manage the business, that compliance plans were out of date, general internal controls were deficient, and key internal staff were not skilled in performing their job responsibilities. These issues culminated in poor billing procedures that caused significant lost revenues.

GBQ led a process to implement the following changes:

• Regulatory compliance plans were developed and brought up to date and a monitoring program was designed to maintain compliance. 
• The practice manager was terminated and GBQ provided interim support, as well as assisted the practice in identifying candidates for the position. GBQ also assisted in training the new manager and hiring new billing staff that could adeptly perform the revenue cycle procedures. 
• The billing department was re-engineered from top to bottom. Policies and procedures were developed and implemented, and key functions for coding and documentation review were outsourced to ensure ongoing compliance and a “best practice” solution. 
• GBQ established procedures for regular monitoring of key management and financial metrics. This information was reported to management and the physicians monthly. 
• In conjunction with the clients, GBQ developed and assisted with implementation of new human resources policies and procedures to establish accountability measures for the staff.

Benefits

The practice significantly improved performance by many measures, both operationally and financially. At the same time, business risk was reduced through hiring the right people, training and oversight, and establishing procedures for regulatory compliance. Revenue improvement results were more than $750,000 per year.