The foundation for any financially healthy hospital or medical practice is a high-performing Revenue Cycle Management (RCM) department. While an efficient medical billing department allows providers to focus on delivering quality patient-focused care, the fact remains that every organization is only as strong as its ability to manage revenue and minimize costs. If a healthcare organization cannot realize profit, providers cannot serve the patient population in need.
The medical billing process is complex and often incredibly challenging. Whether issues arise with claims, payments, or patients, optimal performance can be difficult to achieve. With that in mind, here are some of the biggest challenges medical billing departments face and the solutions to prevent lost revenue.
Let us first highlight a few major reasons why the financial performance of your healthcare organization is suffering.
A recent report found that 86 percent of claims that get denied are preventable. In fact, incorrect coding and billing of medical claims are the most common and time-consuming mistakes made by healthcare organizations.
Coding mistakes can range from a simple typo to miscoding supplies during treatment to reporting codes without proper documentation. On the other hand, billing errors can be attributed to missing or inaccurate information such as mismatched invoices, issuing duplicate bills, or failing to provide documentation to support a claim.
In other cases, inaccurate patient data such as the wrong patient information in a medical record, choosing the incorrect insurance, or mistyping the patient’s address can lead to a range of issues involving claim denials and lost revenue.
Furthermore, because of the pandemic, many payers have updated their billing policies and reimbursement guidelines and, in turn, are closely scrutinizing claims. These changes have also caused challenges for medical coders and billers who are unable to proceed without precise clinical documentation.
As healthcare organizations become more technology dependent, increased importance is placed on revenue cycle departments to consistently reassess their operating structure and workflows to ensure optimal performance. Lack of consistent reviews and audit processes result in lost revenue due to denied claims, time spent on correcting rejected claims, and an overall inefficient billing process.
Lost productivity in your healthcare organization can stem from a variety of issues. One issue is inefficient systems that do not allow physicians, PAs, and clinicians to practice to the top of their licenses. In other words, they are spending too much time on cumbersome systems, paperwork, and administrative tasks.
Another issue is the lack of adequate technology solutions such as billing software or an optimized EHR system. In fact, manual processes for claim submittals is a contributing factor to the growth in denied claims.
The patient’s financial responsibility also has a large impact on the financial health of a hospital or medical practice. Patients may leave bills unpaid due to being uninsured, underinsured, or lack of transparency on their billing statement
Inefficiencies in your revenue cycle department may also result when staff are not adequately trained on how their position plays a vital role in the overall revenue cycle process. For instance, your front-end staff needs to be well trained in how to collect, process, and track patient data. Incorrect processing of that information can result in costly errors such as improper medical coding, billing, and insurance claim filing.
After working with many high-performing RCM departments over the years, we cannot stress enough the importance of finding and retaining billing and coding experts for your healthcare organization. Building a team of seasoned staff members will improve collection rates, increase denial resolution efficiency, patient satisfaction, and overall financial performance for your healthcare organization.
Cross-training is also critical to building a talented revenue cycle department. For instance, different payers may require a specialized workflow or process to meet their specific requirements. Documenting these specialized procedures is necessary so that all staff are aware of their specific requirements.
Furthermore, this will ensure that your team is processing claims in the same manner, documenting them in the same areas, and including all relevant information. From this you will increase revenue and improve processes so you perform – faster, better, smarter.
Using incorrect medical billing software or not using a software solution at all, creates many time-consuming issues that affect operational efficiency of your RCM department. Finding a solution that aligns with your revenue cycle goals is important in the overall success of your healthcare organization. For your convenience, we have provided a guide to the vendor selection process along with a complementary vendor rating tool for your use.
In some cases, technology and cost may be barriers for some healthcare organizations. Therefore, leadership should work closely with their finance and IT departments to search for the proper solution specific to their organization.
Simply investing in a new software solution does not guarantee effective workflows and optimal performance. Proper implementation, on-going training, and support is crucial to ensure your billing team understands how to effectively use the software. For guidance on executing a successful IT implementation, click here. If you need additional assistance with vendor selection, implementation, or staff training, contact us here. Our trusted consultants are here for you and happy to assist.
High-performing Revenue Cycle Management departments generally have one thing in common; close oversight on their end-to-end processes. This prescriptive look at their overall processes allows leadership to see what is working well and what is not. Management that is consistently evaluating their operational model can spot the areas where efficiency can be maximized. This in turn, allows the problem to be solved without evolving into a much larger issue.
Revenue cycle management is not a ‘set it and forget it’ type of work. It takes constant evaluation and measurement to ensure you are making the greatest impact as possible for your healthcare organization.
In one of our recent case studies, our client’s Revenue Cycle Department was currently undergoing a period of evaluation as to the efficacy and efficiency of its processes. They decided to seek outside assistance with specific knowledge of revenue cycle management and strong leadership skills to help identify, prioritize, and implement solutions.
Following an in-depth analysis of the current state of the department, 25 overarching projects were identified as necessary to improve the financial health of the organization. The active and proposed projects sought to either correct deficiencies within the department itself, or complete standard claims and billing work that had not yet been addressed. To read more about this case study and our client’s results, click here.
If you do not have seasoned billing and coding experts, proper ongoing education and training, or adequate software, your healthcare organization will not reap the benefits of a high-performing RCM department. Reach your revenue cycle and reimbursement goals by partnering with one of our RCM consultants. They work alongside leadership and staff to implement process and workflow improvements and training necessary to increase productivity within the clinical, claims, and billing areas of your organization.
For more information on how we can assist with your revenue cycle challenges, contact us at 623.980.8018 or by email at firstname.lastname@example.org
In this featured case study, our client’s Revenue Cycle Department was undergoing a period of evaluation as to the efficacy and efficiency of its processes.
They were seeking assistance with specific knowledge of revenue cycle management and strong leadership skills to help identify, prioritize, and implement solutions. Read the entire case study now and learn how we delivered solutions for our client’s challenges.
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