Revenue Cycle Optimization

Your revenue cycle is the heartbeat of your agency's finances. Every day between service delivery and payment is a day without that cash. Here's how to optimize each stage and keep your business healthy.

Key Revenue Cycle Metrics

You can't improve what you don't measure. Track these:

• Days in A/R: Average days from service to payment (goal: under 45)
• Clean claim rate: % paid on first submission (goal: 95%+)
• Denial rate: % of claims denied (goal: under 5%)
• Collection rate: % of billed amount collected (goal: 95%+)
• A/R over 90 days: % of A/R aging past 90 days (goal: under 10%)

Front-End Optimization

Prevent problems before they become billing issues:

• Eligibility verification: Check before every service, not after
• Authorization management: Track authorizations proactively, get renewals before expiration
• Accurate intake: Get member information right from the start
• Staff training: Billers aren't the only ones affecting billing

Documentation Optimization

Documentation drives billing. Improve it:

• Real-time documentation: Document during or immediately after service
• Completeness checks: Ensure all required elements are captured
• EVV integration: Verified visits ready for billing
• Supervisor review: Catch issues before claims go out

Billing Optimization

Get claims out fast and clean:

• Daily billing: Don't batch weekly—bill as documentation is complete
• Claim scrubbing: Catch errors before submission
• Electronic submission: Faster than paper, with tracking
• Timely filing: Submit well before deadlines

Payment Posting Optimization

Process payments quickly:

• ERA auto-posting: Eliminate manual payment entry
• Same-day posting: Post payments the day they arrive
• Reconciliation: Match ERAs to deposits daily
• Exception handling: Address unmatched payments quickly

Denial Management Optimization

Recover denied revenue:

• Same-day follow-up: Work denials immediately
• Root cause analysis: Fix issues causing repeat denials
• Appeal promptly: Don't miss appeal deadlines
• Track recovery: Know how much you're getting back

A/R Management Optimization

Keep receivables current:

• Weekly A/R review: Know what's aging and why
• Follow-up process: Systematic follow-up on unpaid claims
• Payer relationships: Know who to call when claims are stuck
• Write-off policy: Clear criteria for when to write off

Quick Wins

Start with these high-impact changes:

1. Verify eligibility before every service
2. Bill daily instead of weekly
3. Enroll for ERA from every payer
4. Work denials the day they post
5. Review A/R over 60 days weekly

Building a Revenue Cycle Culture

Revenue cycle isn't just the billing department's job:

• Train all staff on how their work affects billing
• Share metrics with the team
• Celebrate improvements
• Address problems collaboratively
• Make revenue cycle part of regular operations meetings