In a perfect world, your claims would leave your business office “clean” and be paid promptly.

No denials, no delays, and no reductions in payment. But the world of health care providers and payers is not perfect; nor is it simple.

Increasing the number of claims that get paid on the first submission takes time, effort, and quality control. It is possible, however, to apply strategies that help reduce avoidable claim denials – those that could be prevented by your organization – and take a critical step toward improving revenue cycle management.

As a revenue cycle consultant for Zimmerman & Associates in the early 90s, I served as an analyst for the HARA report. For those of you who started your career after it was in circulation or don’t recognize the name, HARA stood for Hospital Accounts Receivable Analysis. At the time, it was the industry-leading publication that discussed healthcare billing best practices and trended major KPIs. Which brings me to my reason for this article - the GDRO benchmark (Gross Days Receivable Outstanding) for a superior performing hospital at the time was anyone reporting 60 days or less.

Revenue Cycle Management is a vast operation for every healthcare organization starting prior to patient intake and continuing on through to financial reporting. Each stage of the healthcare revenue cycle has its own terminology that, for mere mortals (all of us), can increase the complexity of our day-to-day and make the job harder!