Common Revenue Cycle Management Pitfalls to Avoid

common revenue cycle management pitfalls to avoidWhen asked what the key to success is, most business owners will tell you the ability to stay competitive in the marketplace. Staying competitive is particularly important in the health care field where the financial success of a physician practice is fundamentally based on provider productivity and revenue cycle management. A practice that’s unable to reduce revenue leaks and increase their bottom line will have a hard time staying afloat.

When it comes to minimizing costs and managing revenue, medical practices of all sizes make the same mistakes. Here are 7 common RCM pitfalls to avoid at all costs.

 

Not Collecting at Point of Service

Not everyone is comfortable collecting from patients at point of service (POS), but avoiding this sometimes-difficult task can put your practice’s revenue at risk. You know firsthand that copays and reimbursements are a major part of how you and your staff get paid.

Should a payment not occur at POS, a lot of time and money is spent following up and chasing after patients. There are the endless phone calls and emails and paper invoices, and all of those “minor” expenses add up, not to mention the expense of having to hire a collections agency. Multiply these expenses by “X” number of patients and your revenue soon develops a slow and steady leak.

The moral of this RCM scenario is, it’s much harder to get patients to pay once they’ve been treated and are out the door, so make sure your staff has been trained on these procedures and can clearly communicate your collection policies.

Not Submitting Daily Claims

The claims submission process is a time-consuming one and for this reason, many practices put off submitting their claims until the end of the week. This may seem like a benign enough process, but sending out weekly batches can lead to costly delays for your revenue cycle.

A weekly submission schedule increases the chances of a claim becoming lost during the week as well as the turnaround time for each claim being increased. Also keep in mind that for every submission you delay there is a delay in being able to correct and resubmit claims that were denied (of which you will have many more come October 1st.). All of these delays add up to a backed-up revenue cycle. As unhealthy as it is for your patients to be “backed up,” it’s equally unhealthy for your practice’s financial health.

To become even more efficient and profitable, make it a goal to submit claims at the end of each day. If you automate this submission process as much as possible with computer software, you can reduce the time and effort required.

Not Optimizing Time and Workflow

Whoever coined the phrase “Time is money,” must have been a physician. Mismanagement of time (as well as staff workflow) in your practice leads to fewer patients being seen which ultimately reduces your revenue. In order to combat this lost revenue you’ll need to ensure accurate scheduling and that your staff is clear on their individual responsibilities. Also, it is always best to adopt a Murphy’s Law approach into your workflow, meaning, always make provisions for the unexpected to occur (a patient misses their appointment) so valuable time doesn’t get wasted.

Not Keeping Up With Your Payers’ Protocols and Policies

If you think you’re well-enough-informed from reading your insurer’s monthly newsletter, think again. Not staying current with payer policies can really wreak havoc on your revenue. For instance, let’s say a payer changes their identification number but you didn’t know it and submitted your claim with the old number, you won’t just be able to resubmit your claim with the right number. Your system must first be updated to support this modification, which of course means further delays in payment and a sluggish cash flow.

You may be thinking, “How am I supposed to find the time to stay on top of all of my payers?” A great solution to this challenge is to partner up with a revenue cycle management vendor. It is their very business to always understand and maintain current policies, simplifying your claims filing processes and your life.

Not Resubmitting Denied Claims

As good as your coders are, no doubt some of your claims get rejected due to coding errors, an event that will happen much more frequently once ICD-10 goes live this October 1st. When claims get denied, some providers are reluctant to resubmit to certain payers because they don’t have the right tools that allow them access to the data they need to support the challenge. What happens then? Revenue is lost.

A simple solution is to use comprehensive online research tools that always stay up-to-date with the latest information so you can confidently defend your claims. The really good tools will not only point to exactly where the denial occurred but also automate the process of filing appeal letters and corrected claims.

Not Verifying Patient Eligibility

A study by Emdeon (formerly Capario), found that 25% of providers never verify patient eligibility or copay amounts. In our estimation, that’s as essential as checking a patient’s vitals. It gets worse: the study also found that another 25% don’t get around to checking this information until AFTER the patient has left the building. This is a huge pitfall to avoid, especially since copays are increasing as are patient visits. Make sure your staff inquires about eligibility and copay amounts at each and every check-in.

Not Looking for Trends

Most practices are extremely busy, and just getting claims submitted by the end of each day can often feel like a bona fide miracle. But it’s important to make time each week to review claims and monitor for any high-level macro trends that could point to repeated processing errors. Look for a routine denial of claims for certain procedures or code. Finding and fixing these will improve both your short-term and long-term Revenue Cycle Management. You have a lot of data at your fingertips so mine it to understand the common mistakes your office is making, then adjust accordingly.

If your practice is making any of these common mistakes then you are no doubt experiencing not only delayed payments but altogether lost revenue. This simplest way to tackle these pitfalls is to partner with an experienced RCM team.

Alex Tate is a digital marketing specialist, content strategist, and a health IT Consultant at CureMD who provides perceptive, engaging and informative content on industry wide topics including EHR, EMR, practice management and compliance. CureMD helps providers face the complexities of their practice’s financial life by offering end-to-end RCM solutions, as well as denial management and resolution.

 

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