The healthcare revenue cycle is composed of a complex network of connected exercises that includes prior authorization of patients, explanation of benefits and insurance eligibility verification, patient’s demographic data entry, the implication of concerned medical practice procedures, charge admission, medical claim processing, denial management, and electronic patient care report delivery.
Self-practicing doctors in this multi-tiered reimbursement process would lack effectiveness, correctness, and competency, resulting in revenue leakage for the medical practices they deliver to the patients.
Suppose these irregularities and inconsistencies are not troubleshot at the earlier stage, In that case, it could result in the denial of reimbursement from the Payer, that ultimately causes the loss of thousands of dollars.
Your organization must overcome the inadequacy, discrepancy, and ambiguity in your standard reimbursement process, financial operations, and administration to maximize the quality of care and patient outcomes.
Revenue Leakage refers to a situation where healthcare organizations’ in-house billing and physician self-practices result in errors and irregularities in the claim submission process that ultimately prevents them from getting reimbursement for their rendered services to the patients from the insurance organization.
The best and most effective solution to overcome revenue leakage for your medical practices is outsourcing your practice management workflow to a renowned healthcare administrative partner such as MedsIT Nexus.
When you outsource your RCM process, a dedicated workforce specializing in the implication of healthcare procedures for the concerned physician practice and certified by AAPC works aggressively with the insurance company to get the reimbursement for your training.
It would let you submit more error-free claims to the Payer, which ultimately results in the paid claims, faster payments, and minimizes upfront cost, maximizing your overall practice revenue and minimizing revenue leakage by getting payable for your practice from the Payer. The following are the primary impactful methods you can follow to stop revenue leakage in your medical practice:
To minimize revenue leakage in your practice, you must adequately track your reimbursements and payables. Your organization must have a dedicated workforce that works under a meticulous system and must know the standards and protocols to engage Payers consistently to get compensation. Your system must be comprised of innovative solutions and technologies that include medical billing and coding software that could assist your medical billing group in governing an adequate follow-up to reacquire deficiencies with the private and public payers. Moreover, periodic reports will disclose any missed or incorrectly calculated short payments.
Medical Credentialing for the concerned physician practice is a time-consuming procedural process; it can have enormous consequences if done incorrectly, as it is out of the scope of any healthcare organization. Physicians’ self-practices could result in credentialing errors, which would ultimately cause financial losses and revenue leakage for their rendered services to the patients.
Moreover, having issues in the credentialing could also cause delays in the claim reimbursement, financial penalties or disciplinary actions, disqualification from federally supported initiatives, and patient damage. It is far impossible for the healthcare organization to negotiate the ever-changing standards and laws regarding provider credentialing, payer enrollment, and privilege; hence because of their self practices, there are high possibilities that credentialing issues persist.
The only solution to prevent credentialing issues in your practice revenue management process is outsourcing your medical billing and coding needs to a healthcare administrator partner. Outsourcing your practice revenue management process will prevent the physician credentialing mistakes that would ultimately prevent you from financial losses in your medical practices.
Enrollment or a credentialing process requires a substantial workload that can only be managed by a dedicated workforce who can work precisely with detailed attention and patience. Moreover, your staff credentialing for you must be certified by concerned legal authorities to ensure the maximum efficiency in their delivery; this would finally minimize the revenue leakage in your medical practices.
The credentialing process comprises an extreme level of effort and critical complications without the assistance of electronic healthcare resources, including billing and coding software, and the workforce with maximum expertise to use them efficiently. If Your workforce involved in the process goes wrong, filling out the application would result in reimbursement delays and the rejection of the claim.
A law in the united states requires Medicaid practitioners to renew their credentials every three years. This law assures physicians to keep their credentials up to date and compliant with their board certifications and licenses. When hospitals fail to keep up with re-credentialing, physicians and institutions may be forced to conduct treatments for which they are not authorized or licensed. It increases the risk of poor patient outcomes, resulting in costly malpractice lawsuits.
Each insurance provider payer has predefined criteria for the provider or a physician enrollment process in the healthcare reimbursement workflow. It is critical for the individual involved in the credentialing process to meet specific criteria; instead, the doctor will fail to get compensation for his rendered services to the patients, which ultimately causes revenue leakage in his medical practices.
There is too much documentation involved in the practice revenue management process; it is far impossible to structure the process if done manually, resulting in revenue leakage in your medical practices. The following are the significant consequences your organization would face when using non-compliant and outdated software for your revenue cycle management:
One thing that is critical to understand is that the concerned regulatory authorities keep on updating the healthcare procedural coding standards and protocols, so if the documents are stored and managed locally in hard copies instead of using cloud servers, it is a real pain to be updated with the periodic re-evaluations which ultimately cause the loss in practice revenue.
You can significantly improve your revenue cycle by preventing physician enrollment issues in the business processes. Yet, most medical practices do not consider this part serious, leading to consistent credentialing flaws. Hence, medical organizations overwhelm by several financial issues, which cause excessive loss of their practice revenue. Furthermore, additional critical factors are listed; you should consider them for revenue cycle optimization.
It is tough to meet the deadline for the doctor’s credentialing or complete a practice management process for the healthcare organization without automation, which can only be provided by electronic healthcare resources that include medical billing and coding software. Moreover, periodic re-accessing of documents also minimizes the RCM workflow efficiency, ultimately causing revenue leakage for the medical practices of doctors.
When governing a revenue cycle management process, patient data confidentiality and security are significant. Minor negligence could cause a considerable revenue leakage for your medical practices and put your organization into severe consequences related to Medicare regulatory authorities. The patient’s data is vast and must be encrypted and stored in the cloud servers. The medical billing software complying with the Health Insurance Profitability and Accountability Act can only be safely possible.
Medical billing and coding software assists your workforce in identifying errors and inaccuracy in the collection process; moreover, electronic healthcare resources provide multiple solutions for problems that can solve immediately.
Medical billing software can utilize detailed and meticulous patient data stored within the system to create a productive billing process system. It minimizes the claims rejections that ultimately prevent revenue leakage for your medical practices and accelerate the flow of revenue for your healthcare organization.
An Explanation of Benefits is a document sent by Medicare or an insurance provider to the patient after receiving medical services from a physician and submitting a claim for the reimbursement request.
Medical providers are unaware of the protocols and standards of the insurance provider for the claim submission, hence there self practice in preparing claims makes errors in the healthcare procedural codes implication for the rendered services.
These mistakes would have a severe impact on your practice revenue and could cause a severe and endless revenue leakage for your medical practices that ultimately create financial consequences for your organization.
Unbilled procedures are a crucial element that causes revenue leakage in medical practices because of untrained and incompetent medical billing and coding staff. Your medical billing staff must be capable enough to identify billed and unbilled coding procedures; because of the Physician’s incompetency, some healthcare coding procedures are not recorded in the speculation that they are not billed. After a thorough discussion with the physician, a skilled medical coder may typically assist in identifying revenue leakage owing to unbilled treatments.
Medical procedural billing and coding become more complex and directly affect the other relevant circumstances, including health plans, secure patient payments, etc. Many payers manipulated this process manually, resulting in healthcare procedural errors. Now, the healthcare industry is getting advanced because of modern technologies, including Automated correspondence management, which automates the process, drastically reducing data entry costs and eliminating paper use.
To facilitate the patients and accelerate the payment process, providers want to issue bills right after providing the service. Lack of technology in your practice management workflow causes delays in getting reimbursement from the Payer, resulting in revenue leakage for the provider’s medical practices.
When your medical billing and coding department doesn’t hold a contract management system to calculate the expected payable amount, they lack proper tracking of reimbursements and underpayments.
Your billing and coding staff must assist an excellent system to recover deficits from internal or external insurance companies with consistent follow-ups. Specific organizations in the healthcare industry lack the tracking management system to maintain rejections from the payer, which cause claim losses within the system and only shows up on older reports after a while.
Typically, management systems miss this type of income loss; they reappear too late, and payers refuse to settle their outstanding balances. Generating periodic reports can tackle basic requirements for such circumstances to prevent revenue leaks in medical practices. A revenue management expert can help you determine whether data is appropriate for reporting.
It is critical for the concerned authorities in your organization to keep track of the patient’s help desk workforce performance and ensure they are working right and up to your practice’s standards.
Their minor negligence, such as exclusions or feeding incorrect data, will cause devastation to your system. Hence, your front desk has a significant role in minimizing revenue leakage in your medical practices because they make appointments and populate vital patient data into the system, including medical problems, patient records, and insurance information.
MedsIT Nexus Medical Billing And Coding Services comprise leading electronic healthcare resources that include healthcare procedural coding software that assists our workforce in maintaining financial health and reducing revenue leakage for your medical practices. Connect with us today to discover more about our dedication to excellence and performance for medical practices and healthcare providers, or ask questions about our customized revenue cycle management systems or other medical billing services.
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