How to Avoid Common Revenue Cycle Management (RCM) Mistakes

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Collecting cash from patients is a mighty task for most healthcare providers. 73 percent of organizations state that collecting payments from consumers takes one month or more. To add to that, some patients may not even be able to pay all their dues because they didn’t anticipate the expense. Your medical billing and coding team deals with these issues daily. In this post, we discuss what major issues plague the RCM process and how healthcare providers can deal with these common Revenue Cycle Management mistakes.

7 Common Revenue Cycle Management Mistakes to Avoid

Not Staying Current with Payer Requirements

This Simply going through your insurer’s newsletter isn’t enough. If there’s a change in the provider identification numbers’ structure, a simple claim resubmission doesn’t solve the problem. Healthcare providers need to dedicate time and keep their systems up-to-date with their payer’s requirements. By not updating insurers’ payment terms, you increase administrative errors and delay payments even further. You also end up increasing claim reject rates and admin expenses.

Solution

You can partner with a revenue cycle management vendor to reduce your workload and simplify claims filing processes. Ensure your partners always maintain the latest policies and help you with their expertise.

Not Addressing Higher Volume of Work Effectively

Finding the right people to manage your revenue cycle is critical because they have access to confidential documents. Constant demand in the market and limited budget issues may mean that your current staff takes on more workload than it can handle. This move can easily backfire on your team and reduce the overall efficiency tremendously. If you don’t find ways to handle the increasing workload, you’ll quickly face roadblocks and backlogs. When push comes to shove, your team may neglect some accounts unconsciously. 

Revenue Cycle Management Blunders to Avoid
Revenue Cycle Management Blunders to Avoid

Solution

Initially, focus your staff’s attention on the early accounts receivable processes. Ensure your staff files claims accurately and timely. This move ensures quicker claims processing and faster payment cycles. Make sure your team extracts payments within the 30 days after rendering services. By focusing on these payments, you’ll either receive cash or denials that need proper processing. Prioritize the most recent balances because they’re the ones most likely to be completed successfully. If you can, consider outsourcing your old balance reimbursements to a reputed firm. 

Not Collecting at the Point of Service (POS)

It might be awkward to collect money from your patients at the time of service. However, avoiding this task may jeopardize your practice’s revenue. If a payment doesn’t happen at the POS, your provider will spend a lot of time and money to follow up and chase patients for payments. Expenses like following up through calls, emails, paper invoices, and hiring a collections agency add up. This sum multiplies with the patient count and causes a lot of harm to the revenue collections.

Revenue Cycle Management Blunders to Avoid
Revenue Cycle Management Blunders to Avoid

Solution

Train your employees to politely request your patients for early payments. You could also consider incentivizing them through various schemes. 

Not Submitting Daily Claims

Processing claims is a time-consuming and detail-oriented procedure. Hence, many staff members delay payments until the end of the week. Though it may seem harmless, this common practice delays payments and costs your healthcare provider greatly. A weekly processing schedule increases the chances of losing a claim during the week. This schedule also extends the payment cycle and ensures late payment. In case you receive a denial, correction and resubmission delays the collections process even further. Simple scheduling malpractice has a cascading negative effect on the entire process.

Revenue Cycle Management Blunders to Avoid

Solution

Focus on filing claims every day and reducing your workload significantly. Use automation tools as much as you can to improve process efficiency and reduce time and effort while you avoid this revenue cycle management mistake.

Not Verifying Eligibility and Benefits 

With laws mandating citizens to have medical coverage, more people are opting for high deductible plans. So, most healthcare providers deal with insurers to receive payments. Without proper identity verification and eligibility checks, organizations risk losing their revenue from the payer. An industry report states that 25 percent of medical practitioners don’t verify eligibility immediately. You verify details by checking whether the medical service is covered through the patient’s insurance. Through eligibility checks, you also ensure that you pre-certify or ask for authorization if it’s necessary. Most importantly, you’ll understand how much the insurer will cover and how much the patient owes.

Solution

Check for real-time eligibility through various automation tools. Get information about the patient, payer, and the plan in detail. If you have any doubts, don’t hesitate to pick up the phone. You could also use various cost estimation tools to convey costs with transparency. 92 percent of customers want to know their costs before visiting for the first time. 

Not Measuring Performance

It’s difficult to fix issues that you don’t recognize. Since ASCs are busy, they can often neglect to monitor their revenue cycles with useful metrics. So, any issues with the collection rates, accounts receivable days, claim lags, or other issues remain unresolved. These problems often pile up and wreak havoc on the collections process.

Solution

You can incorporate measurement and reporting software to track important milestones in the revenue cycle. Measure the current conditions of the ASC’s performance, and set goals for the future.

Not Being More Proactive about Managing Referrals

Referral leakage averages between 55 and 65 percent of revenue. Many health agencies don’t track and analyze referral data effectively. Without proper knowledge about these referrals, they cannot pinpoint the specific area of their business that drives growth. A prominent example is not tracking inquiry calls for future business opportunities. Through tracking and following up on these inquiries can help medical providers get a clear picture of the flaws in their conversion rates.

Solution

Through data-driven programs, you can improve partner relations. Subsequently, you can consider attractive rewards for good employees.

Conclusion

Many issues impact the revenue cycle management process. You can avoid most of these issues by encouraging your staff to be more efficient and using relevant automation tools effectively. So, take advantage of our solutions today!

Systematized revenue cycle management in healthcare is the key to smooth administration for hospitals and other medical institutions. Invensis Technologies, a leading Healthcare BPO Services company, delivers comprehensive Healthcare and Medical Revenue Cycle Management Outsourcing Services; our services range from pre-registration and scheduling of appointments to coding and billing. We have achieved HIPAA compliance and are ISO 27001 and ISO 9001 certified. In adherence with these standards, we offer a systematic approach which ensures the safety of patient information and maximizes the efficiency of our clients’ operations.

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