How to Arrest Revenue Leakage in Medical Billing?
Top 10 Strategies to improve reimbursements
The Revenue Cycle is a complex maze of connected processes through which hospitals, physician practices, and healthcare systems manage and collect payments for the care services delivered to their patients. These include prior authorization of patients, insurance and eligibility verification, patient registration, medical coding, charge capture, claims submission, payment posting, denial management, and report generation. Inefficiency & carelessness in these stages can cause revenue leakage, which if undetected, could result in the loss of thousands of dollars.
As you work hard & try to keep the lights on, MBW brings you 10 things that you can implement to reduce revenue leakage in your practice. These best practices will help you improve revenue and reduce your costs.
1. Avoid Credentialing related Denials
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.
2. Un-billed Procedures
Physicians must be aware of billable procedures to not leave minor procedures unrecorded. Educating physicians on billable procedures decrease instances of un-billed procedures and improves revenue. An expert medical coder can usually identify revenue leakage due to un-billed procedures after having a detailed discussion with the physician.
3. Un-billed Claims
Un-billed 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.
4. Managing Patient Balances
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.
5. Underpayments
One of the highest sources of revenue is knowing exactly what your services cost. Underpayments can be avoided by planning & revising your fee-schedule as per the various insurance companies promptly. Seek expert assistance in defining your fee-schedules
6. Fee-Schedule problems
Fee-schedule issues can be resolved by updating your schedule every month. This way your practice can identify the areas where you’re being paid less. For a procedure, fix your fee schedule 2 to 3 times the Medicare’s allowable charges.
7. Inefficient claim denial management
Denial management is a crucial step in revenue cycle management and requires to be handled with utmost expertise. 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.
8. Personnel Issues
Personnel issues are caused due to the inefficiencies or improper training of the reception desk & billing department. Train your front desk staff to capture data accurately while handling patients with care & empathy. Entrust your billing process to qualified and certified individuals who can submit bills and follow up promptly.
9. Unleash the power of Analytics
Most revenue cycle software, today, offer a set of reporting features. Use these features to generate timely reports on the operational & financial performance of your practice. Apply the key lessons learned from the data for root cause analysis and while making important decisions.
10. Patient Centricity
As a healthcare organisation, your primary responsibility is patient care and satisfaction. Create clarity about patient responsibility, introduce flexible payment methods, and form a customer service team that maintains consistent communication with your patients.
About the Authors
Vinod Sankaran is the CEO of Medical Billing Wholesalers. He is focused on developing solutions and services that reduce and eliminate the inefficiencies in the healthcare system.
Melvin Miller (Satish Chander) is COO of Medical Billing Wholesalers. As an operations leader, Melvin looks at hundreds of healthcare processes and applies technology and process rigor to help our clients achieve the financial outcomes that they seek.
To get a deeper understanding of these issues causing revenue leakage in medical billing & strategies to arrest them, download this white paper from Medical Billing Wholesalers.
