An efficient and effective revenue cycle is integral to running any successful medical practice. Timely payment from insurers and patients is essential for practices to maximize their collections. The financial impact of a mismanaged revenue cycle is massive as it spreads out over a large volume of claims. There are some common, and easily avoidable, mistakes made by providers that contribute to a mismanaged revenue cycle.
The first common mistake is not remaining current with modifications at the payer’s end such as a change in the provider identification number. The system should be updated to support payer’s modifications to maintain a consistent cash flow. An easy solution would be to use the expertise of a revenue cycle management vendor.
Another common mistake is not managing the claims process in a systematic way so that the provider is able to get automated alerts for denials and track the issue at any point of the claim cycle. Using the right technology to follow up the claims could easily alleviate this problem.
A third common mistake is not resubmitting rejected claims to insurance companies. Whenever a claim gets rejected due to an error in codes, many providers feel reluctant to resubmit the claim. However, this causes the revenue to be lost. To avoid this issue, providers can search the Internet for any updates in the processes in order to help them know the reason for the denial and the process of filing corrected claims.
Not verifying patient insurance eligibility or checking co-pay amounts is another common mistake. If you ignore the co-pay during a patient visit, multiple visits will lead to increased amounts in bad debt write-offs. However, automated software tools can be used to conveniently check real-time insurance eligibility and co-pay.
Finally, the most common mistake, especially at very busy practices with a high administrative load, is that the macro trends are often ignored when processing too many claims one at a time. As a result, the same mistake is likely to be made over and over again and opportunities to alleviate the situation can be missed. Thus, to conserve administrative time and expense workflow, revenue cycle management software can and should be used in order to avoid rejections and greatly reduce revenue loss.