Healthcare revenue cycle management is the financial process that facilities use to manage the administrative and clinical functions associated with claims processing, payment, and revenue generation. The process encompasses the identification, management, and collection of patient service revenue. The industry-wide transition from fee-for-service to value-based care reimbursement will bring changes to traditional revenue cycle management.
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, Viaante brings you 9 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. Incomplete or un-billed procedures
Incorrect coding causes poor patient care and trouble with reimbursements. Physicians must be aware of all the billable procedures and ensure not leaving minor procedures unrecorded. Educating physicians on billable procedures decrease instances of incomplete and 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 physicians.
2. Incomplete, un-billed or inaccurate Claims
Incomplete, un-billed or inaccurate claims result in the loss of more revenue than any other reason. Also, the inaccurate and bloated claims can be damaging to the company’s performance and its reputation. These claims can be identified by comparing reports of patient’s appointments, procedures performed & claims submitted.
3. Avoid Denials related to Credentialing
From small private practices to large health systems, healthcare organizations must navigate the constantly evolving requirements and regulations surrounding provider credentialing, payer enrolment and privileging. These functions are necessary to run a profitable practice and deliver quality patient care. Factors such as a payer merger, missed re-credentialing notice, payer policies or amendments may have impacted the status of providers’ participation in certain plans and these need to be looked out for. 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.
4. Managing Patient Balances
Patient balance collection not only requires organizational support and effective processes, but also standard regulations which need to be followed by the medical billing service provider. The company must 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 and Fee-Schedule problems
Underpayments can often go unnoticed and cause lasting effects to your bottom line. 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. These 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.
7. Incompetent claim denial management
Denial management is a crucial step in revenue cycle management and requires to be handled with utmost expertise. The purpose of a Denial Management Process is to investigate every unpaid claim, uncover a trend by one or several insurance carriers, and appeal the rejection appropriately as per the appeals process in the provider contract. 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. Patient Centricity
As a healthcare organisation, your primary responsibility is patient care and satisfaction. Studies suggest patient-centric care can benefit other important outcomes. On the business side, patients who report positive experiences have more trust in their providers and are less likely to switch physicians, allowing for more continuity in care. On the technical side, patients simply respond better. Create clarity about patient responsibility, introduce flexible payment methods, and form a customer service team that maintains consistent communication with your patients.
9. Staff or Front Desk related Issues
Staff or Front Desk related Issues are caused due to the inefficiencies or improper training of the reception desk & billing department. Ensure that proper training is provided to the 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.
Keeping your practice financially healthy is critical, and we’re here to help. If you’re looking for assistance and a cost-effective way to streamline billing and coding for boosting your bottom line, you should definitely opt for outsourcing medical billing to India. Viaante is one of the top medical billing companies in India havingexperience and expertise in the medical billing and coding procedures. With over years of experience especially in the Healthcare BPO domain, Viaante provides comprehensive medical billing and coding services. Our streamlined administrative operations ensure healthy and to know more, click here https://www.viaante.com/industries/healthcare/provider/medical-billing/