The Challenges Associated with Revenue Recovery and How to Solve Them

Delivering high-quality patient care is just one of the parts of a successful healthcare organization. An effective revenue cycle is crucial to drive better patient experience, and satisfied staff and makes the healthcare organization’s financial performance healthy.

However many healthcare organizations often struggle with revenue recovery. This is a process of identifying and recovering revenue leakage from missed payments, pricing errors, and billing mistakes.

During the process, there are many challenges associated with it. Tackling all the challenges is essential to increase healthcare practice profitability.

This blog post shares the common challenges associated with Revenue Recovery and how to solve them.

What is Revenue Recovery in Healthcare?

Revenue recovery is an important aspect of healthcare providers. It makes sure that every healthcare provider gets correctly reimbursed for the service they provide. 

Having a strategic revenue cycle for your healthcare is crucial to prevent any coding errors, insurance dependencies, and other complex procedures.

• Healthcare providers must use the proper codes when billing for procedures and diagnoses.
• Healthcare organizations must have systems in one place to ensure that bill for all services and supplies used during the patient visits.
• Providers need to submit claims properly, follow-up unpaid claims, and appeal denials.
• Healthcare providers can identify areas of improvement by identifying areas where there losing revenue and take steps to recover those funds.

In common, revenue recovery in healthcare helps the healthcare providers receive the payments for providing care for the patients.

Related: The Ultimate Guide for Independent Practices to Master Revenue Cycle Management

Challenges in Revenue Recovery

Challenges exist in every part of healthcare operations as well as the patient’s journey. From the initial stage to accessing through billing and claims, until the account is settled or moved. 

Here are the common challenges associated with revenue recovery for healthcare practices:

1. Billing Errors and Claim Denials

• One of the most common challenges in revenue recovery is medical billing errors and claim denials. 
• The claim denials usually occur when the practice submits the claims, then the insurance companies reject it for some reason.
• Common reasons for claim denials include coding errors, authorization issues, and insurance eligibility issues.
• Medical Coding errors may happen when the patient’s information is incorrect, coding for the medical services is erroneous, or mismatched services and charges.
• Claim denials create a loop of submitting claims, receiving the denial, correcting the claim, resubmitting claims, and waiting for the response from the insurance companies.
• This significantly drags down the revenue cycle by expanding the time of billing and receiving payment.

2. Compliance Issues

• In the healthcare industry, regulations and compliances constantly change at the federal, state, and even local levels.
• For instance, the No Surprise Billing Act required good-faith estimates for patients without insurance or who were not utilizing insurance, and it attempted to restrict unexpected medical expenses, mostly from emergency care. 
• When it became operative in 2022, billing departments had to adapt quickly. 
• Falling behind these regulations can increase claim denials, payment delays, and staff turnover.
• So, it requires a professional to stay in charge of monitoring the changing regulations and compliance.
• This ensures that the healthcare organization can quickly adapt to the change to keep updated.
• But for some practices like small healthcare hospitals, it is a big challenge because of the lack of resources.

3. Inefficiency in Revenue Cycle Management

• Revenue Cycle Management (RCM) is one of the best ways to maintain the healthcare organization’s financial health.
• Inefficiency in RCM can lead to a huge loss of revenue for healthcare practice.
• In this way, healthcare practices often delay medical billing, claim submissions, and payment posting.
• However, it is possible to improve the RCM Performance by taking advantage of revenue recovery. 
• Healthcare practices can make changes in RCM to get the most out of Revenue Cycle Management.

4. Uncompensated Care

Research by the American Hospital Association shows US healthcare providers accumulated nearly $745 Billion in uncompensated care between 2000 and 2022.

• Expecting payment for treatment without getting it is a huge source of income leakage. 
• If it is improperly handled, it can get out of control. 
• Beyond the financial consequences, the burden of uncompensated treatment and revenue collection issues affects patient happiness, hospital staff morale, and overall quality of care. 

5. Self-Pay Patient Mismanagement

• Patients who do not provide any source of insurance coverage have different levels of challenges, unlike other categories.
• Payment via insurance coverage is not guaranteed and providers have to take extra steps to settle the account.
• Settling down the account involves many steps within the workflow.
• There are chances where patients might slip through, may human errors occur, eligibility claims can be denied, and loss in healthcare practice revenue.
• The process is different and more dangerous than insured accounts. 

Related: 8 Actionable Steps to Increase Your Practice Revenue by 10x with RCM

Solutions to Tackle These Revenue Recovery Challenges

Every challenge which we have mentioned above is commonly happening in healthcare practice. 

However, the challenges are many in revenue recovery, you can easily tackle them with effective solutions to overcome them. Here are the comprehensive solutions to solve the revenue recovery challenges.

1. Improve the Payment Collection Process

• One of the effective ways of tackling the revenue recovery challenges is to improve the payment collection process.
• There are many ways you can improve the payment collection process. Here are some of the ways:
• Keep communication open and share details on insurance options, pricing, and hospital policies.
• Let patients know their financial responsibilities as soon as possible.
• Send billing statements that are clear and easy to understand for patients to avoid confusion.
• Request payment before or at the time of service. Because patients who leave without paying may require more time and resources to collect the payment.
• Allow patients to submit their information ahead of appointments.
• Offer convenient payment methods like online, phone, or mail.

2. Utilizing Health Tech Solutions and Automation

• Health technologies and automation are revolutionizing the industry.
• Streamlining most of the repetitive tasks and reducing the workload for patients.
• You can utilize software solutions and health IT systems to reduce manual work and human errors which may lead to billing errors.
• Advanced software can be able to reviewed for inaccurate coding before claim submissions.
• Provide patients with online portals where they can directly message their care team, schedule appointments, pay medical bills, and be actively involved in their care.
• Health tech solutions can streamline most of the repetitive administrative tasks including some of the revenue cycle management process.
• However, utilizing health tech solutions and automation leads to many new challenges.
• To tackle that, Begin by outlining the reason for the change, why it is necessary, and how it will improve work in each area. 
• By demonstrating to employees what’s in it for them, the transition from old software begins with a higher possibility of cooperation.

3. Train Staff to Stay Up-to-date

• Small mistakes can lead to breaking down the whole process of the revenue cycle.
• Healthcare practices should adequate comprehensive training sessions for all departments to reduce inconsistencies and uneven patient experience.
• The training sessions should include internal systems and policies while keeping them up to date with the changing regulations, trends, and coding.
• Additionally, Provide roleplaying, coaching, scripting, and monitoring, particularly for staff members who interact with patients. 

4. Patient-Centered Approach

• To improve revenue recovery, it is required to adopt the patient-centered approach.
• From the initial stage of RCM to the final payment, should be easy for the patients to understand and to navigate.
• This will ensure the creation of more loyal patients, who are more likely to return, recommend services to their surroundings, and pay bills on time.
• Implementing the patient-centered approach as a whole can be a daunting task. 
• Healthcare practices can start small by optimizing practices online presence with a website.
• Ensure your website looks neat, clean, and easy to navigate to helpful links and resources.
• Then consider implementing software to support a patient-first culture such as online portals and enrollment platforms.

5. Enhance the Revenue Recovery Process

• An inefficient revenue cycle can lead to many problems throughout the patient journey.
• Good improvements only happen when all the staff members from the front desk to the billing person are on board for commitment to revenue recovery goals.
• Managers of the revenue cycle can analyze trends, pinpoint underlying issues, and implement solutions. 
• It’s usually preferable to pinpoint one issue at a time rather than trying to solve them all at once.
• This includes focusing on coding and billing accuracy, quickly addressing claim denials, improving the patient intake process, and upgrading patient outreach and engagement.

Vozo Revenue Cycle Management to Increase Your Practice Revenue

At Vozo, we understand your struggle in navigating through all the revenue cycle processes such as regulations, medical coding, and reimbursements. 

That’s why we bring the best cutting-edge service to optimize your revenue cycle management from start to finish. Here’s how Vozo can help you to transform your practice’s financial performance.

• Automated tools for error-free coding and faster reimbursements
• User-friendly billing to keep patients satisfied and payments flowing
• Robust data security and compliance protocols to protect your practice
• Detailed reporting and analytics for smarter business decisions
• Solutions that grow alongside your evolving needs

With Vozo RCM service, you can reduce the headaches associated with revenue cycle management and focus on what matters the most – quality patient healthcare delivery.

“Partner with Vozo RCM Service and unlock the full potential of your healthcare practice and maximize its revenue”.