March 2020


Taking a “waste walk” through your revenue cycle management process

by Sara Burns Rapuano

Source: Sara Burns Rapuano


As an ophthalmology practice management consultant, over the years I have often been asked to review practices’ billing office operations. The nature of these reviews has changed as insurance plans have shifted much of the burden of healthcare costs to patients with higher deductibles and copayments. Reviewing the billing office is not enough. We need to look at the entire revenue cycle. The revenue cycle starts when your call center answers the phone to make that first appointment and ends when the office collects all payments due from insurance and patients.
Of course, the revenue cycle is much stronger if it operates in a lean and professional manner that encourages the patient to return to your practice. There are opportunities for operational improvement in every part of the revenue cycle. Operational improvements can increase your revenue as well as decrease your costs. A “waste walk” of your revenue cycle focuses on decreasing those costs. When we identify waste, we create a strategy for improving operations by reducing those wastes, and most importantly we create feedback loops to ensure continuous improvement. A key part of process improvement within the revenue cycle is using the full capabilities of your practice management and electronic health record software.

Revenue cycle management process

I suggest you execute a “waste walk” of your practice by evaluating seven touchpoints in your revenue cycle. The touchpoints to look at include: the call center, the reception desk, the technician team, the physician, the surgical coordinator or the optical shop, the billing department, and the accounts receivable follow-up process. Because accurate coding and compliance needs to be considered by everyone, it is at the center of all of these. We hope your patients complete this cycle over and over. By analyzing the complete patient life cycle/revenue cycle, practices can improve their bottom line.

Identifying waste

Waste can take many forms. At its core, it is anything that does not add value to the process. Our computer systems can be a huge source of waste if we do not use them correctly. Some sources of waste in each step of the revenue cycle are:

Call center tools u

We waste staff time by having them perform functions that can be done by a computer. This is a waste of human talent. Review your appointment schedule templates to eliminate the need for any external tools. Use the capability built into your software. Send automated reminder calls, emails, or texts. Generate no-show letters automatically. Do pre-visit registration by gathering all patient information when you make the appointment so you can check eligibility before a patient shows up in your office. You waste patient, physician, and staff time when you must cancel a patient who shows up without a referral or with non-participating insurance.

Registration/check-in tools u

Use integrated credit card processing and electronically sign HIPAA and financial responsibility forms. This reduces the total steps for the registration team.

Technician tools u

Technicians waste time data entering data that could be imported through interoperative EHRs. Use the patient portal for pre-visit forms. Use medication history imports. Accept CCD documents from referring doctors.

Physician tools u

Consider customizing EHR templates. Use favorite diagnoses and macros. Consider mobile applications to support doctors on call.
Surgical scheduling: Build surgical templates with direct message or fax forms to facilities directly.

Billing process u

Use claim edit capabilities. Review your rejection and denial reports. Make sure your billing service adds value by reducing your staff workload. If they don’t, bill in-house.

Accounts receivable follow-up u

Make sure you’re the coach in this team sport. Use reporting that highlights the root cause for claims denials. Share the root cause issues with the team. This is the continuous improvement part of the lean management approach to your revenue cycle.

Take the next step

Evaluate each component of your revenue cycle to identify waste and use software capabilities effectively to reduce that waste. Staying current on your software application is critical to continuous process improvement. Ongoing education and training available through your software provider can enable you to maximize revenue and minimize wasted time and money. With the reduction in reimbursements we must reduce costs to increase our bottom line.
The resounding takeaway is stay current on your software’s capabilities. Proactively manage your software and operationalize the use of that software to make your office run more efficiently. Lastly, find a software provider that offers a full suite of flexible and scalable services.

About the author

Sara Burns Rapuano

Ophthalmology practice
management consultant 
Philadelphia, Pennsylvania



Taking a “waste walk” through your revenue cycle management process Taking a “waste walk” through your revenue cycle management process
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