Revenue Cycle Considerations for Recurring Outpatient Services
Recurring outpatient services, such as behavioral health, oncology treatment, physical medicine rehabilitation, and wound care, require distinct attention from a revenue cycle perspective. An error on a recurring service account can result in costly impacts on patient experience, cash flow, and organizational reputation. Success depends on consistent communication, education, and collaboration between revenue cycle teams and service lines.
Patient Registration & Eligibility Verification
Accurate patient registration is critical. Eligibility should be verified not only before the first visit but also regularly throughout the treatment period, especially for services spanning multiple months. A monthly eligibility verification cadence - both verbally with the patient and electronically through your clearinghouse - helps prevent eligibility and authorization denials.
If a change in payor or payor plan is identified, a defined workflow must trigger authorization requests from the new payor/plan before continuing care.
Collecting patient responsibility payments at time of service is a best practice that will avoid costly self-pay collections and bad debt expense. Revenue Cycle leaders can provide scripting for patient interactions that supports the organizational policy and mission.
Decentralized Registration
In decentralized registration environments, clear communication from the Patient Access/Revenue Cycle team to all staff performing registration is essential. All staff performing registration tasks should receive updates on:
- Regulatory and form changes
- Payor requirements and newsletters
- System updates affecting registration workflows
Including new staff in Patient Access onboarding and routine education strengthens understanding of registration and verification processes.
Authorization Management
Recurring service authorizations can be complex. Whether obtained by the referring provider or a centralized team, authorization details must be clearly communicated to the service line team.
- Quantity-based vs. date-based: Know the authorization type for each patient and track usage or expiration date closely.
- Treatment changes: New authorizations may be required when treatment protocols, medications (including shifts to biosimilars), or medical conditions change. All treatment changes must prompt documented communication with the payor for authorization of change.
- Extension requests: Submit before the existing authorization lapses to avoid care interruptions or denials.
A reliable process for tracking decrements and monitoring changes in care plans is key.
Coding Considerations
Evaluating coding workflows for recurring services may shed light on improvement opportunities. Oncology and wound care coding are complex; it is best practice to have coding specialists in these disciplines.
Training clinicians on clear, concise documentation standards to allow appropriate coding and modifier use results in accurate revenue realization. Federal and state regulations for the service line are also important considerations for certain services.
Service Line Engagement
Engaged service line leaders are strong allies in protecting revenue. By understanding documentation requirements, coding nuances (including modifiers), and payor-specific rules, they help reduce vulnerabilities that erode contribution margin.
Best practices include:
- Routine documentation and coding reviews with educational follow-ups
- Incorporating revenue cycle topics into staff meetings (documentation, coding, eligibility, authorization, denial trends)
- Encouraging collaboration with revenue cycle experts to navigate complex billing scenarios
Denial Prevention & Resolution
Denials, especially eligibility and authorization, should be communicated from the Revenue Cycle Team to the service line staff immediately so they can address issues before additional care is rendered.
Schedule regular denial review meetings to:
- Identify root causes
- Adjust workflows
- Educate teams on prevention strategies
These meetings are most effective when they are collaborative, solution-focused, and educational.
Is your revenue cycle for recurring services operating at its best? If there’s room for improvement, the Microscope team can help you close gaps and protect your revenue.
For more information, please contact:
