2026 Gastroenterology Reimbursement and Coding Update (Virtual) | November 2025-Strengthening Revenue Cycle Management from Start to Finish

Pdf Summary

This presentation from AskMueller Consulting, LLC focuses on strengthening revenue cycle management (RCM) in healthcare from start to finish, covering both front-end and back-end processes that impact accounts receivable (AR). AR in healthcare represents money owed by patients and payers, critical for cash flow and financial health. <br /><br />The front end begins at patient registration, including insurance verification and eligibility checks at appointment scheduling or arrival. Important tasks include patient education on financial policies, collection of co-pays upfront, and ensuring preauthorization for procedures requiring medical necessity documentation. Financial counseling is emphasized to assist patients with payment plans, hardship qualifications, and loan options.<br /><br />Common front-end errors such as incorrect insurance data, missing preauthorization, and incomplete demographics can delay payments and increase AR days. Moving into the transition zone, accurate claim submission with correct primary diagnoses, valid orders, appropriate modifiers, and proper documentation is critical. A claim scrubber software is recommended to catch demographic, eligibility, coding, and documentation issues prior to payer submission.<br /><br />On the back end, key functions include payment posting, denial management, AR follow-up, and timely appeal of denied claims. Denial management tips include verifying eligibility, preauthorization, coding accuracy, and regular staff training. Timely claim filing within payer-specific limits is essential to avoid denied payments. Underpayments should be promptly identified and addressed using loaded fee schedules.<br /><br />Effective patient balance collections require clear policies and consistent financial communications while minimizing reliance on external collections agencies. Internal policies and cross-department collaboration between front desk, billing, coding, and providers are vital to reduce errors and improve revenue. Regular monitoring of key metrics such as AR days, denial rates, and clean claim rates is advised.<br /><br />Best practices include standardized workflows, investment in staff training and technology, and frequent communication to adapt to payer updates. Overall, a collaborative team approach is emphasized to maximize revenue and practice financial success.

Asset Subtitle

Kathleen A. Mueller, RN, CPC, QMC, QMGC, CCS-P, ICD-10 Proficient
Kristin Vaughn, CPC, QMC, QMGC, CPMA, ICDCT-CM

Keywords

Revenue Cycle Management

Accounts Receivable

Patient Registration

Insurance Verification

Preauthorization

Claim Submission

Denial Management

Payment Posting

Financial Counseling

Healthcare Billing