Your ophthalmic practice may have a designated billing department or financial director, but each person in the practice plays a role in revenue cycle management (RCM). This fact should not be overlooked by you or the individuals whose daily responsibilities are essential to the practice's financial performance.
Practices generate revenue by providing ophthalmic services to patients. The process of billing and collecting for services is the revenue cycle. Breakdowns in that process lead to increased workloads and delays, affecting cash flow and the overall profitability of the practice. Review the revenue cycle and identify the roles and responsibilities necessary to complete the steps.

Schedule Management 

• Allocate appointment types for each physician, factoring in volume, patient access considerations and profitability.
• Keep appointment slots full by reducing cancellations or no-shows.
• Note the reasons for patient visits to streamline the flow and identify possible prior authorizations.

Patient Demographics

• Collect accurate and complete data; ensure names are spelled correctly, collect exact dates of birth, current addresses, valid insurance carrier(s), and identification number(s).

Eligibility and Authorizations 

• Obtain insurance eligibility verification and coverage details prior to service.
• Determine patient responsibility to collect at the time of service.
• Note payer requirements for referrals and/or prior authorization (obtain when needed).

Patient Encounter

• Provide medically necessary care based on the patients' chief complaint and/or treatment plan.
• Follow unique payer policies.
• Provide comprehensive documentation to support medical necessity payer policies and facilitate correct coding.

Coding 

• Select CPT code based on descriptor and chart documentation.
• Appropriately link covered diagnosis codes and applicable modifiers.
• Stay abreast of relevant guidelines and changes, including medical code updates.

Individual roles must effectively collaborate with each other to achieve a well performing revenue cycle. Ensure that members of the clinical team understand their RCM responsibilities and recognize the importance of their role. Refine Your Revenue Cycle: Roles and Responsibilities Part 2 identifies steps necessary to achieve clean claims and remittance posting as well as timely collections