Reconciliation Best Practices for Revenue Cycle Accuracy

National Medical

National Medical

Top Five Questions to Ask When Establishing Reconciliation Workflow


Reconciliation process diagram

When a patient steps into your surgery center at a scheduled date and time for a surgical procedure, the visit must be documented to reconcile it against the charges the patient eventually receives. This is the basic principle surrounding appointment and charges reconciliation.

Establishing a systematic checks and balances workflow to your reconciliation process ensures all information is accurate and accounted for before a claim is posted and billed.

Best practices include:

  • Receiving and reconciling operative notes to your surgery center’s schedule on a daily basis;
  • Running a weekly unbilled report from the practice management system to uncover any cases that are scheduled without a charge posted in the system;
  • Confirming cases on the unbilled report are accounted for on either the missing information report or are in the process of being coded;
  • Reviewing missing information reports on a weekly basis to track down outstanding documentation needed to properly code cases including missing or incomplete operative reports, pathology reports, implant logs, and medical records.

During a Becker’s Hospital Review webinar, National Medical’s President Lisa Rock discusses the value of running a weekly unbilled report, and how this best practice helps to resolve discrepancies in your scheduling notes.

Watch our 60 second webinar video clip to learn more:


View the full webinar (1 hour) The Business of Powering Profitability: 5 Overlooked RCM Processes ASCs Must Review Before the End of the Year for Financial Success

Questions to ask diagram


Lisa also answers the top five reconciliation questions to further detail the benefit of establishing a reconciliation workflow:


  1. Why should all cases for all entities be scheduled?
    The biggest benefit of scheduling is to stay current on patient progress and to track whether that patient has a pending, booked, or cancelled appointment. The cleaner the information, the easier the reconciliation process is. For example, if a pending case isn’t updated as being performed or cancelled, those cases will continue to show up on your unbilled report. This leads to problems with revenue cycle accuracy since those cases aren’t actually unbilled.

  2. How do you keep track of cases that require additional documentation for coding?
    All software managements systems have unbilled reports. Run the unbilled report every week to keep track of your cases and look for missing information. This process will also help you keep notes as clean and as up to date as possible.

  3. Can the charge posting order impact reimbursements?
    The charge posting order for reimbursements matters and can significantly impact the total reimbursement you can collect per case. It’s important to sequence charges based off each payer’s managed care contract language and methodology.

  4. What happens when a case is added to the schedule days after the date of service?
    It becomes harder to reconcile those cases, especially if the procedure required prior authorization and the payer was not notified. Your facility’s surgery appointment schedule and the actual performed cases should match, and medical records should be attributed to each of the performed cases. By running an unbilled report on a weekly basis, it’s easier to keep track of all cases and submit claims in a more timely fashion.

  5. How do you navigate unbilled reports?
    While many facilities like to run unbilled reports at the end of the month, reviewing 30 days of notes can be tricky to manage. It’s even harder to get through a monthly unbilled report if the cases aren’t marked properly or if the scheduling notes aren’t kept clean. Assigning a point person to mark cases as the information changes will help to simplify the process. Running the unbilled report on a weekly basis will make it easier to keep track of the status of each case, plus claims that are ready to be posted and billed can be submitted faster.

Automation can also help improve your surgery center’s reconciliation process. The ability to auto-schedule reports such as weekly unbilled reports can help streamline your workflow, especially if your key objective is to improve the accuracy and efficiency of your revenue cycle.

To learn more, access our webinar The Business of Powering Profitability: 5 Overlooked RCM Processes ASCs Must Review Before the End of the Year for Financial Success.



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