7 Quick Actions To Fix Your Revenue Leakage In Medical Billing

In today’s healthcare system, the two most important things every healthcare provider should keep a big eye is on delivering quality care and improving patient outcomes.

Your revenue cycle management will be associated with claims processing, payment collection, and revenue generation. So, a healthcare practice needs to take a deep look at their revenue leakage and fix it immediately.

What leads to revenue leakage?

The revenue cycle is a process through which healthcare practices manage and collect payments for the services they offered to patients. What kind of stages are all included in revenue cycle management? Right from prior authorization of patients, insurance verification, eligibility verification, patient registration to medical coding, charge capture, claim submission, denial management patient posting, and report generation – everything included and small mistakes in these stages may cause you revenue leakage.

Thinking about the solutions to fix revenue leakage? Here, Vozo listed out some of the best 9 steps you can follow to reduce your practice revenue leakage in medical billing.

7 quick actions to prevent revenue leakage

1. Be accurate with provider enrollment data

Provider data is one of the most important assets in the delivery of healthcare. Consumers of provider data include all IT systems (EMR, credentialing, marketing), patients, and payers. Poorly managed provider data delays revenue cycles, impacts clinical quality, creates compliance risk, and negatively impacts marketing (referral and patient). Complete and accurate provider enrollment fillings are an important step for medical practices.

Medicare, other governmental payers, and commercial insurance carriers will simply deny claims when forms are filed without complete and/or accurate information. The best case in that event would be that your billing staff has to work harder to get what the practice is owed.

2. Identify un-billed or inaccurate Claims & Procedures

Incorrect coding causes poor patient care and trouble with reimbursements. Physicians must be aware of all the billable procedures and ensure not leaving minor procedures unrecorded. Educating physicians on billable procedures decrease instances of incomplete and unbilled procedures and improves revenue. An expert medical coder can usually identify revenue leakage due to unbilled procedures after having a detailed discussion with the physicians.

Also incomplete, un-billed, or inaccurate claims result in the loss of more revenue than any other reason. These claims can be identified by comparing reports of patient’s appointments, procedures performed & claims submitted.

3. Avoid denials related to credentialing

From small private practices to large health systems, healthcare organizations must navigate the constantly evolving requirements and regulations surrounding provider credentialing, payer enrolment, and privilege. These functions are necessary to run a profitable practice and deliver quality patient care.

Factors such as a payer merger missed the re-credentialing notice, payer policies or amendments may have impacted the status of providers’ participation in certain plans, and these need to be looked out for. Practices should understand that ignorance of non-participation of a provider with certain health plans can increase denials.

Credentialing should be performed by a professional team that understands the nuances of payer-specific credentialing and re-credentialing requirements and helps you reduce denials. Outsourcing your credentialing process can reduce denials significantly.

4. Manage patient balances effectively

Patient balance collection not only requires organizational support and effective processes but also standard regulations which need to be followed by the medical billing service provider. The company must build a seamless patient balance management process consisting of timely reminder calls/texts to patients, electronic payment methods & flexible payment plans to ensure maximum reimbursements.

RELATED: Why Is Accurate Payment Posting Important In RCM?

5. Concentrate more on fee schedule problems

Setting a proper fee schedule (price) for every procedure you provide can be daunting. Setting your fees too low will result in lost revenue. Setting your fees too high can be negatively perceived by patients. Setting fees not consistent with any benchmark will make it hard to keep overall tracking of your fee structure in a way that makes sense.

Set your fee schedule as a percentage of the current year’s Medicare rates, usually between 2 and 3 times the Medicare allowable for each procedural code for primary care physicians and a higher multiple for specialists. Make sure you run monthly reports that will highlight if your fees are being paid at 100% of your gross charge by any payer. If so, your fee schedule is likely too low, at least for that payer.

6. Claim denial management

Denial management is a crucial step in revenue cycle management and requires to be handled with utmost expertise. The purpose of a Denial Management Process is to investigate every unpaid claim, uncover a trend by one or several insurance carriers, and appeal the rejection appropriately as per the appeals process in the provider contract. Hire a professional team who can resubmit denied claims, understand the reasons behind denials & create an iterative process to prevent future denials due to the same issues.

7. Manage front desk staff issues

Problems at the front end of any sequential process can create havoc downstream. And your front desk staff is at the front end of your revenue cycle. They take patient appointments, they enter patient demographics, and most importantly, they enter and update patient insurance information into your PM system.

Very often the correct insurance payer is identified but the wrong insurance plan for that payer is attached to a patient account. Or patient insurance in the system is not updated correctly because it takes some discipline at the front desk to continually check patients’ insurance for changes. All of these issues can result in claim denials and lost revenues.

Review and update your front desk policies and procedures with downstream revenue cycle implications strongly considered. Simple straightforward fixes upfront can greatly impact your bottom line. Once improved, front desk performance should be monitored empirically by RCM dashboard reporting. Denials (unpaid claims) that are caused by front desk errors and omissions should be consistently tracked to make sure that this aspect of revenue cycle leakage is permanently fixed.

Vozo Revenue Cycle Management Services

• Our highly experienced coders ensure that the best-approved combination of procedure and diagnosis codes is used to ensure maximum payment and instant approval.
• We offer the best denial management services according to the physician’s practice needs and revenue cycle requirements, to optimize the practice’s cash flow.
• We leverage advanced technologies to provide fast, inexpensive, and secure accounts receivable follow-up services.
• We work successfully with all federal and commercial payers and have strong knowledge of their payment mechanisms
• Our medical billing reports are structured in a precise manner and can be customized to meet the specific practice needs for financial analysis.
• Our comprehensive approach of technology elevates the billing cycle process to an end-to-end revenue cycle management solution that improves cash flow and enhances profitability.

Let us know how we can help you to fix your revenue leaks!