Financial Management: Level 2

Develop and distribute revenue cycle reports to relevant departments

Collect and analyze revenue cycle reports focused on immunization services to gain insights into the root causes of reimbursement losses. Communicate these findings to relevant departments to help address recurring errors, such as inaccurate billing or coding, and guide corrective actions.

Over time, lost reimbursements add up and negatively impact an organization’s cash flow and revenue stream. By tracking relevant revenue metrics for immunization services—including coding inaccuracies, denied claims, and claims resubmissions—organizations can identify root causes of lost reimbursement and take corrective action. For guidance on developing and distributing revenue cycle reports, consider the steps below.

Step 1:

Identify relevant departments

Determine which departments should be captured in and receive revenue cycle reports. You’ll want to consider all locations where immunization activities take place. Common departments include:

  • Primary care (immunizations of all kinds)
  • Pulmonology (for pneumococcal vaccines)
  • Geriatrics and rheumatology (for flu vaccines)
  • OB/GYN (for Tdap vaccines)
  • Cardiology, endocrinology, oncology, hematology, allergy, and immunology departments

Step 2:

Collect and analyze data

Develop a revenue cycle report that captures relevant data for immunization activities. This report may take the form of a dashboard or scorecard at the clinic, department, or provider level and can include metrics such as:

  • Number of immunizations administered
  • Charges and net collections from immunizations
  • Number and types of denied claims or resubmitted claims 
  • Coding errors, such as submissions with inaccurate or incomplete data

Step 3:

Communicate report findings and corrective actions

Distribute revenue cycle reports to relevant departments. To ensure findings are carefully reviewed, enlist lead providers or pod leaders to meet with clinic managers and discuss these reports in detail. During these meetings, participants can discuss the clinic’s current performance, compare performance against peers, and identify areas for improvement that will be incorporated into billing and coding education and tools. These meetings are also a good opportunity to discuss corrective actions (e.g., errors that need to be corrected and resubmitted for payment) and set measurable goals for improvement. Managers should determine a time to follow up and review whether actions taken have had an impact on performance or reimbursement.

To increase success rates, teams may consider:

  • Summarizing reports to reinforce conversations
  • Reviewing reports regularly and frequently (e.g., monthly) to catch negative trends before they become larger problems
  • Reporting metrics by staff member to inform individual education and improvement efforts 
  • Continually emphasizing business impact (e.g., steady, complete reimbursements depend on timely, accurate coding and filing)