Common Revenue Cycle Management Mistakes - and How to Avoid Them

June 18, 2021 by Antonio Arias, MBA, CHBME

Topics: Revenue Cycle Management, Practice Management

Revenue cycle management

Running a successful and fiscally responsible medical practice involves many moving parts and pieces. One of the most critical factors to long-term success is having a streamlined revenue cycle management process. There are some errors frequently made along the way, however, so read on to learn to recognize and avoid them!

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What is Revenue Cycle Management, and Why Does it Matter?

Revenue Cycle Management (RCM) refers to the process of identifying, collecting, and managing the medical practice’s revenue based on the services provided. A successful RCM process is essential for a healthcare practice to maintain financial profitability and continue to provide quality care for its patients in the long-term future.

Poor billing practices can result in financial losses and potentially put the ability to deliver quality care at risk. Striving to improve and streamline core operational procedures can help providers remain fiscally successful, and ensure the practice has longevity.

The revenue cycle begins when the patient makes the appointment and ends with successful payment collection. However, there are many steps in between that must be accurately and efficiently completed to ensure timely payment. The opportunities for human error abound due to coding complexities, miscommunication, medical billing errors due to duplicate data, and missing information or misspellings, which can result in lost revenue.

How Can Clinic Bottlenecks Affect Efficiency?

With an effective RCM system, healthcare organizations can keep costs down and focus on improving patient outcomes. When an integrated billing and coding system is employed, care providers can achieve higher rates of clean claims and fewer past-due patient payments, resulting in higher revenue and profits.

Streamlining your medical practice’s administrative operations only results in positive advantages for your clinic. From a higher clean claims rate to optimized billing cycles, it’s critical for the long-term success of your medical practice that bottlenecks are actively prevented!

Medical billing

Common Revenue Cycle Management Mistakes

Here are some of the most common revenue cycle management mistakes frequently made at medical practices that hurt performance metrics.

Operating with Fragmented Administrative Processes

The front and the back end of the office often have different priorities, but if information isn’t freely flowing between the two, it can result in mistakes and claim denials. Improved communication during patient intake on coverage eligibility can assist with payer coordination and claims reimbursement, as well as improve payment collections.

Be sure to focus on front-end administrative tasks to expedite claims and to assist uninsured patients in understanding their coverage options with insurance exchanges. Confirming patient insurance information is often overlooked with subsequent visits and can result in eligibility denials.

Patient Insurance Eligibility Issues

Speaking of eligibility denials with patient insurances - communicating with health insurance companies is a key component of your medical practice’s revenue cycle management process. Neglecting to manage the claims process after submission can result in pending, rejected, or denied claims, or ones that were never even received. Tracking claims to determine where problems originate, such as determining if there are issues with specific procedures or codes, can help increase awareness and reduce recurrences, which ultimately streamlines your medical practice’s revenue cycle.

Not Tapping into Technological Resources

Poor quality data and future revenue cycle complications can occur without the ability to streamline the digital workflow. Developing strong supporting healthcare IT infrastructure can assist with revenue cycle management, and the ability to process necessary reports. The implementation of an electronic workflow can also help to seamlessly coordinate front and back communication and eliminate lost paper documentation. There are numerous technologies available to help optimize your medical practice’s operations!

Problems with Patient Payments

The patient’s responsibility for healthcare costs is growing; if patient payments are collected before or during their service, then the risk of non-payments is avoided completely. Although this is often a challenging task since many patients struggle to afford high deductibles or have a general unawareness of their financial responsibility.

Patient pre-registration is essential to gaining the most accurate information about their medical history and insurance information upfront to reduce claim denials. This can permit front-loading the payment process by gathering data about insurance coverage, additional insurance, their maximum allowable visits, and determining the patient’s financial responsibility, which positively impacts your revenue cycle management processes!

Medical billing and coding

Ways to Avoid Bottlenecks and Increase Efficiency

Avoid common revenue cycle management mistakes by following these tips below:

Get your Administrative Team on the Same Page

Maintaining a cohesive strategy for your administrative team empowers your medical practice’s overall revenue cycle management process. For example, claims that are filed promptly—and filed correctly—are paid first. By concentrating on these early dollars, you’ll either receive payment or you’ll get some kind of denial or appeal that can be resolved, and which allows you to maximize reimbursement. Generally, the most recent balances are also the most collectible. Don’t allow your staff to shift focus to more aged balances unless all early balances are being collected with proper rhythm and rigor.

Implement a Proactive Approach to Patient Payments

Consider creating an outbound calling strategy for your medical practice to actively - and gently - reach out to patients regarding their statements. Not only does this drive more patient payments, but it can also improve the overall patient experience and fortify a relationship with them. Only a small portion of patients pay from their statement alone; when you actively reach out to call them, your total payments will naturally grow. In general, patients often just need a little extra information, an explanation, or sometimes a nudge to decide to pay. If there are more significant roadblocks to them paying, you can explain their payment options or work to create a custom payment plan for them.

Allow NCG Medical to Handle Your Medical Billing Needs!

Outsourcing your medical billing can tremendously improve your practice in terms of internal and external efficiency. A medical billing firm can equip your practice with 24/7 reporting via analytics, for example, or can act as an in-house electronic health records (EHR) expert. In doing so, the outsourcing service can help ensure that incentive program adherence doesn’t drag your team’s time away from patients.

With NCG Medical, you’ll gain a team of experts in your corner who can help navigate the worlds of medical billing, healthcare software, and more! Contact us today to learn how we can make your practice more efficient, enable better patient access, and ensure you give the most effective care.

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