Medical revenue cycle since its introduction has made it possible for healthcare facilities to improve their cash flow and generate revenue more efficiently. Not only for health practitioners, but the revenue cycle has made bill payments easier and accessible for patients too.
With its benefits, comes numerous mistakes that occur either intentionally or due to lack of focus. However, there could be a lot of reasons, but all result in the same and that is missed revenue opportunities and the facility’s reputation decline.
Today we are going to tell you the top errors associated with the medical revenue cycle that you must avoid if you want to secure more revenue.
An Outlook To The Medical Revenue Cycle
Increased revenue loss of hospitals by not having a proper financing system made this revenue cycle process come up. After its implementation in the health industry, hospitals and clinics got relief from struggling to make patients and insurance companies pay for their services.
The medical revenue cycle is a procedural method that helps hospitals align their cash flow. The process involves conducting patients’ medical services, preparing claims, capturing codes for each service, sending the claim to the insurance payers, getting the reimbursement, and transmitting the remaining bill to the patient to complete the revenue cycle.
This system keeps revenue generation under one umbrella, by following which health facilities manage their claim processes. They can keep an eye on which claims are accepted and rejected so that they can resolve payer objections and get the payment.
Revenue Cycle Errors
Despite having professionals working under your health facility and using softwares in the medical revenue cycle, many health practices become the victim of some pitfalls that result in an enormous amount of revenue loss.Â
Not paying attention to the medical revenue cycle and conducting the process carelessly without proper insight awareness may lead to an increased number of claims and revenue denials. However, here are some errors we have mentioned that you can read and do preparations to avoid them.
Lazy A/R Follow-Up
A/R means accounts receivable. When you as a health facility provide a treatment, patients and insurance payers owe you a certain amount of bill. These bills must be made sure to be paid otherwise you can miss huge revenue opportunities. One way to get these bills are A/R follow-ups.
These follow-ups are conducted during medical revenue cycle, when the payer shows a late response. You must make sure to execute quick and regular follow-ups with the patients and insurance payers. Since late claim applications response decreases the chances of getting a reimbursement.
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Improper Documentation
Claim denial is a nightmare of every health practice and many errors contribute to it including inaccurate documentation. Along with the claim application, there are many documents and information that need to be attached. Any missing or inaccurate patient and coding details are promptly denied by the insurance payer, which makes the reimbursement process lengthier.
Besides, coding and spelling errors may also be the cause of claim denials. So before delivering the application to the payer, make sure it includes all the necessary documentation.
Misleading Records
During the medical revenue cycle when a patient’s treatment has been completed, the bill is filled with the patient’s data. Then the medical bill is submitted along with an accurate patient record. Any mistake in those records may confuse the medical coder about which service to capture code for.
You must make the records error-free, as it helps medical billers know the charges that need to be mentioned in the bill. You must also make sure that the reports have been signed properly by all professionals involved in the treatment.
Lack Of Physician Recognition
When an insured patient gets medical treatment, they must be directed to those physicians that come under their insurance plans. Because insurance companies consider paying only those patient’s bills that take treatment with specified physicians.
However, some health facilities instead of paying heed in this matter direct a patient to any random physician. After which, when patients receive the bill, they get an unexpected surprise as they were expecting the insurance company to pay their charges.
Hence, most patients show slow responses toward a surprise medical bill, sometimes they can’t even pay the bill due to their poor financial conditions. This can lead to slow revenue generation and bill payment cutouts if the patient has gone towards medical debt.
Poor Debts
Bad debt means you are not paid the full amount of your health service by the patient. As mentioned above, surprise bills are a huge contributing factor to bad debts. But there may be some other reasons for bad debts, all of which negatively impact your medical revenue cycle.
The only solution is to regularly and constantly monitor paid and remaining bills. Keep records of all patients and maintain regular follow-ups to get your payment.
Claim Denial Game
Many factors may cause a claim application to be denied in the first go, including a lack of awareness about handling claims. In-house hospital staff needs to execute application preparation and submission flawlessly to get quick reimbursement. However, if your staff is not educated enough about managing claims, your revenue is always at risk.
Opt for hiring professional medical billers and other medical revenue cycle staff. They prepare and submit a claim as soon as possible after the treatment is completed. No doubt, skilled coders and billers double your chances of generating additional revenue.
Manual Claim Management
As manual claim applications have more chances of containing errors, it can be an alarming situation for your revenue. Where technology has created solid ground in the healthcare industry, there are still some health facilities that don’t employ innovation. Instead, they conduct manual claim processes and face constant revenue loss.
Besides getting help from a professional medical coder, you can install EHR/EMR systems, that can help you automate the medical revenue cycle. From patient eligibility verification to claim submission, this software can handle your entire RCM process.
Conclusion
No matter what is the extent of your health facility, small or big, you must carefully conduct the medical revenue cycle to get your payments on time. For this not only do you need to use advanced RCM procedures, but also know some of these errors. It will help you avoid future mistakes and generate those revenue amounts that can be lost due to lack of attention.