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PRACTICE HEALTH CHECK: REVENUE CYCLE MANAGEMENT RESPONSIBILITY MATRIX
PRE-VISIT RESPONSIBILITIES
Patient Intake - Clinic
Complete all pre-visit paperwork, including consent forms, scheduling, demographics, insurance information, eligibility verification, fee schedule details, PCP, Date Last Seen, referrals, and authorizations.
Patient Intake - 2 B Billing
Not Applicable
VISIT RESPONSIBILITIES
Patient Encounter - Clinic
Verify/reconfirm demographics and insurance information, collect copays, self-pay, and outstanding balances. Develop a protocol for payment collection. Enter encounter details with appropriate ICD-10 coding, supported by detailed medical notes signed/finalized within 72 hours of the visit.
Clinical Documentation- Clinic
Ensure all providers complete clinical documentation, including procedure notes and encounter details, and sign/finalize documentation within 72 hours of service.
Patient Encounter - 2 B Billing
Not Applicable
Clinic Documentation - 2 B Billing
Not Applicable
POST-VISIT RESPONSIBILITIES
Claim Handling - Clinic
Not Applicable
Documentation Queries- Clinic
Coordinate to resolve documentation queries or discrepancies affecting coding or claim accuracy.
Missed / Incomplete Encounter Follow-Up- Clinic
Coordinate to resolve documentation queries or discrepancies affecting coding or claim accuracy.
Payment Posting - Clinic
Upload all insurance mail, paper EOBs/checks, and patient payments for posting.
Patient Statement Submissions - Clinic
Manage paper statements for patients if chosen.
A/R, Payer Outreach, Denials, & Appeals - Clinic
Handle patient A/R follow-up, reports, and collections.
Financial Reporting & Analyses - Clinic
Track practice performance.
Patient Refunds - Clinic
Process patient refunds accurately and timely.
Payer Portal Access - Clinic
Process patient refunds accurately and timely.
Claim Handling- 2 B Billing
Scrub claims for appropriate coding/modifiers and submit to the clearinghouse or mail within two business days of finalization. Correct rejected/invalid claims and collaborate with providers for necessary updates. Establish a claim correction protocol.
Documentation Queries - 2 B Billing
Coordinate to resolve documentation queries or discrepancies affecting coding or claim accuracy.
Missed / Incomplete Encounter Follow-Up - 2 B Billing
Not Applicable
Payment Posting - 2 B Billing
Ensure accurate and timely posting of payments (EOBs, EFTs, ERAs, uploaded patient checks) into the client’s practice management system.
Patient Statement Submissions - 2 B Billing
Routinely submit electronic statements based on the client’s frequency.
A/R, Payer Outreach, Denials, & Appeals - 2 B Billing
Follow-up on and resolve insurance-pending encounters. Identify and work with the practice to enable electronic submission/access for all insurances.
Financial Reporting & Analyses - 2 B Billing
Deliver monthly, bi-annual, and annual payment summaries.
Patient Refunds - 2 B Billing
Not Applicable
Payer Portal Access - 2 B Billing
Not Applicable
ONGOING MAINTENANCE RESPONSIBILITIES
Maintenance of Satellite Locations & Facilities - Clinic
Notify 2 B Billing of changes to existing locations. Ensure all satellite locations are credentialed and enrolled. Maintain accurate, up-to-date information, communicate billing/enrollment changes, and provide access for coordination.
Maintenance of Patient Demographics, Insurance, PCP, & Date Last Seen - Clinic
Regularly review patient demographics and insurance information. Establish a protocol for this review.
Maintenance of Fee Schedules - Clinic
Responsible for creating, reviewing, and maintaining all applicable fee schedules. Provide current/updated fee schedules, notify 2 B Billing in writing of changes, ensure compliance, review periodic reports, and respond to inquiries.
Bank Reconciliation - Clinic
Solely responsible for timely and accurate bank reconciliations, including reconciling accounts against posted transactions, investigating discrepancies, ensuring all deposits/payments/transfers are accounted for, and maintaining supporting documentation.
Maintenance of Satellite Locations & Facilities - 2 B Billing
Not Applicable
Maintenance of Patient Demographics, Insurance, PCP, & Date Last Seen - 2 B Billing
Flag accounts with missing, outdated, or inconsistent information that impacts billing/claims.
Maintenance of Fee Schedules - 2 B Billing
Apply fee schedules accurately for claim submission, reimbursement tracking, and reporting.