Whether you're a physician or a hospital, you're probably suffering from some kind of issue. That issue is probably affecting both your revenue and cash flow. Unless you have a crack staff, which means you've been able to keep all of the people in your facility trained on revenue cycle processes that affect them, something's lacking.

Could a revenue cycle review help? Yes it can, for many reasons. Here are 5 of those reasons:

1. Are you comfortable that every charge you could possibly capture is being captured? Are you sure that the charges being captured are the procedures, supplies and pharmaceuticals that are actually being used or performed? Not only could this cause revenue problems but it can also cause billing and compliance issues, both of which affects cash at some point.

2. Are you confident that the charges being captured match up with your diagnosis codes? There are two problems that can occur here. One, medical records doesn't code everything, and physicians sometimes have office staff send over codes instead of doing it themselves. Two, in hospitals where procedures in departments such as endoscopy are in the charge master instead of capturing timed charges and then having medical records code them, procedures selected by the department and what medical records codes based on what physicians say actually occurred can be different. These are both compliance issues that can also lead to claims being denied.

3. Are you confident that your charge master is not only up to date, but that the codes you're using are valid for the departments you're using them for? If you're coding because you know you can get a higher reimbursement rather than coding accurately, that's not only a compliance issue but that's fraud, and the consequences aren't worth it. If you don't know that it was done previously an audit will help find those problems.

4. Denials can occur for a number of reasons, and all of them take a toll on your cash collections. Sometimes having someone on the outside take a look can correct problems and bring great benefits. The problems could be with registration, charge capture, coding, or even computer processing errors. When every person on your staff is already so busy that they can barely keep up with the workload, having someone else do a revenue cycle review can help immensely.

5. Not only do you have to worry about revenue and cash issues but all types of audits. There are Medicare and Medicaid audits, RAC audits, OIG reviews and probably reviews by more local insurances such as Blue Cross. No provider ever wants to have to give money back and possibly deal with bad press at the same time. True, hiring someone to come into your business to do a review will cost you some money, but a review by a competent company will always offer your more financial benefits than the cost.