Streamline Your Revenue Cycle: Part 1

Part 1: Begin with solid policies and procedures.

By Linda Martien, CPC, CPC-H, CPMA

Being a practice manager means you must know where the buck stops in your facility or office: Who is accountable for what? Can you measure staff performance? What is your policy for conflict resolution, collections, appointment no shows, absenteeism, etc.?

These questions beg for clearly written, specific policies and procedures that will serve as roadmaps for your organization. When staff know the expectations, consequences, and boundaries, confusion and conflict are minimized. A well-defined, streamlined workflow will naturally improve employee productivity, as well.

Start with the Operations Manual

One of the best ways to increase the efficiency of your entire practice is to create an operations manual. Although you may think operations manuals are only for large corporations, even small medical practices benefit from their use.

Operations manuals set standards for all practice employees to follow. This negates some excuses employees may have for not performing their duties properly. Manuals may also help cut the costs of employee absenteeism. According to Forbes Magazine, unscheduled absenteeism costs employers $3,600 per employee, per year ( You can deflect this loss by incorporating a policy in your operations manual that allows employees to fill in for other employees in the event of an absence. Manuals also are handy in the training process. Instead of guiding new employees personally through each operation, there is a guide to consult.

Creating an operations manual is a low-cost way to improve your practice from within. Here’s how to create a medical office operations manual:

  1. Take note of day-to-day operations. You may want to jump right into creating your operations manual, but it’s best to observe the daily operations of your practice for one to two weeks. This will give you a better idea of what your manual needs to cover.
  2. Pay special attention to the table of contents. Make sure it’s detailed. Use headings and subheadings to make specific tasks easier to find.
  3. Create job descriptions. Although you may have kept your staff for years, turnover is inevitable. Create detailed job descriptions in the manual to help ease the transition for new employees and to resolve conflicts between employees in regards to responsibilities.
  4. Enlist office experts to create certain sections. If any employee is especially adept at a particular task, have that person write an explanation and “how to” steps for the manual. This will ensure the task is explained thoroughly and will help others to perform it properly.
  5. Be concise. An operations manual isn’t meant to be an exceptional piece of literature, but it needs to be useful and understandable. Keep it simple.
  6. Operationalize common situations. Certain things aren’t part of your operations, but still occur at times. For instance, include a section in your manual for dealing with dissatisfied patients.
  7. Keep it open to revision. A key to an effective operations manual is that it needs to change with the times. Technologies and procedures change, so make sure to review and, if necessary, update your manual every six months.

Create Policies Geared Towards Better Workflow

Next, consider these miscellaneous workflow questions:

  • Have tasks been clearly defined by job responsibility?
  • How will you make the transition from paper records to electronic health records (if you haven’t already)?
  • Do you have an ongoing training and development plan for all employees?
  • Have all job areas been identified to improving workflow success?
  • Have you evaluated the layout of the office and patient areas?
  • Do you have the most current and up-to-date health information technology?

The success of your medical office largely depends on how well the front-end staff performs. When creating policies and procedures, you must consider:

  • Registration Accuracy: The cycle of a patient account originates with the initial entry of patient demographic and insurance information. Invalid information will delay payment.
  • Scheduling Efficiency: Does your medical office have a high “no show” rate? One way to reduce no shows is to use online patient scheduling. Patients can manage, schedule, or reschedule their own appointments, which makes “no shows” less likely.
  • Patient Satisfaction: Providing high quality care and excellent customer service will prevent loss of revenue for the medical office due to a high level of patient satisfaction. Periodic surveys, both oral and written, will target problem areas and help you to reward superior staff performance.

Additional policies related to the front desk should include:

  • Greeting patients and answering phones: A smile and a personal greeting will make your patients feel welcome at your office. Remember that seeing a doctor can be a stressful situation, and a friendly face may help to alleviate some anxiety.
  • Providers who are running far behind: Notify patients and allow them the option to reschedule.
  • Confirming and updating patient demographics: Do this every visit.
  • Patient check out and co-pay/co-insurance collection: When a patient checks out, have the patient pay his or her co-insurance or co-pay in full. This also can be done on the front end during check in, especially for co-pays, when the exact amount due is known.
  • Scheduling the next appointment: Always try to have a patient schedule his or her next appointment before leaving the office. When a new patient schedules an appointment, have him or her bring completed new patient information forms, medical history, insurance cards, etc. Make these necessary forms available on your website for patients to print and fill out before coming in (even if the appointment is the next day). This will accelerate the intake process and shorten patient waiting times.
  • “No shows” and cancellations: Develop a policy to address missed or cancelled appointments within a certain time frame. You can assess a penalty or charge a fee, but you must have this policy in writing, and patients must be informed.

Consider these and other policies and procedures for your operations manual to make your front office run efficiently and cost effectively. In Part 2 of this revenue cycle management series, we’ll address the patient contract.

Linda Martien, CPC, CPC-H, CPMA, brings her 30+ years of experience in coding, billing, auditing, management, and consulting to healthcare. She is employed as Director of Reimbursement at Cytomedix. Martien is a member of the AAPC Chapter Association board of directors for the 2014-2017 term and has served as a past member and officer of the AAPC National Advisory Board. She has served in officer positions for the Columbia and Jefferson City, Mo., local chapters.


Renee Dustman

Renee Dustman

Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.
Renee Dustman

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Renee Dustman is executive editor at AAPC. She has a Bachelor of Science degree in Journalism and a long history of writing just about anything for just about every kind of publication there is or ever has been. She’s also worked in production management for print media, and continues to dabble in graphic design.

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