Are you struggling to manage your revenue cycle effectively?
Do you face common roadblocks that hinder your ability to operate efficiently and reach your collections potential?
If so, you’re not alone.
Many healthcare providers face similar challenges when optimizing their revenue cycle management (RCM) workflow. To overcome these hurdles, healthcare providers must implement a system that can track claims, ensure accuracy in coding and billing, and provide real-time insights into the performance of the revenue cycle.
In this article, we will explore some of the most common roadblocks that healthcare providers face when it comes to RCM and practical strategies for overcoming them.
4 Common Roadblocks in RCM + Ways to Fix Them
Roadblock #1: Lack of Insurance Verification and Eligibility Checking
One of the most common roadblocks in the revenue cycle is the need for insurance verification and eligibility checking. Insurance companies reject claims when there are any mistakes or missing details. So, if you don’t verify a patient’s insurance coverage and eligibility, you risk losing money on services that are not covered or not reimbursed.
A report by Change Healthcare found that 23.9% of claim denials occur because of errors during the registration and eligibility process. This contributes to almost 25% of claim denials which could have been prevented.
This is why verifying the patient’s coverage and eligibility is crucial before providing services. This helps ensure you are not left paying for services that are not reimbursed.
Solution: Have a Streamlined Insurance Follow-Up and Verification System in Place
Dealing with insurance follow-ups can be difficult and time-consuming. This is why having a dedicated team to follow up on insurance matters is essential. This team can proactively verify a patient’s insurance eligibility before receiving healthcare. Customize software and tools to verify coverage, check eligibility, and estimate patient responsibility.
If you’d prefer, you can also consider hiring a third-party vendor to handle this task instead of spending hours on the phone dealing with insurance companies and patients.
Roadblock #2: Inaccurate Coding and Billing Errors
Medical coding and billing accuracy are crucial to the financial well-being of your healthcare practice. However, errors in coding and billing are prevalent and can significantly impact your revenue cycle. These errors can arise due to coding complexity, miscommunication, duplicate data, and missing information, leading to lost revenue, delayed payments, and additional stress on your staff.
For example, a medical coder using the wrong code for a specific treatment can lead to claim rejection. Similarly, a billing specialist entering incorrect patient information, such as a false insurance ID, can result in payment denial.
Solution: Employ an Expert to Navigate Complex Account Billing Processes
Healthcare practices can avoid inaccurate coding and billing errors by hiring experts to handle the medical billing process. They can help streamline the medical billing and coding process, reducing the chances of mistakes and claim rejections.
When it comes to medical billing, specific standards like 5010 and 837/835 are essential for the accurate and efficient submission of claims. To streamline the billing and payment process and minimize errors and delays, it’s vital to have an expert in these transaction standards who can automate the process. This will improve coding and billing accuracy, decrease claim rejections, and ultimately enhance your revenue cycle.
Roadblock #3: Denials and Appeals Processing
Denials and appeals processing can be a major hurdle in your revenue cycle. Denials can happen for various reasons, such as incorrect coding, missing information, or lack of medical necessity. Denials can lead to a significant loss of revenue and increase the workload of your billing team. Going through appeals can be time-consuming and complex.
Solution: Improve the Claim Verification Process
To cut down on the time your team spends on denials and appeals processing, you need to make sure that you have a proper system in place for submitting claims.
For example, you can improve your claims submission process by verifying patient insurance information upfront, ensuring accurate coding and billing, and promptly following up on denied claims.
This will help identify the root cause of denials and implement corrective actions to prevent future denials. You can also outsource this process to an expert team to manage the appeals process from start to finish — including gathering all necessary information, submitting appeals, and following up with insurance companies.
Outsourcing your denials and appeals processing can also provide the following benefits:
- Reduced workload for your billing team
- Increased revenue by reducing denials and improving collections
- Improved cash flow by getting denied claims paid faster
- Access to expertise and technology that may not be available in-house
Roadblock #4: Delayed or Missing Payments and Debt Collection
Late or missing payments can cause major problems for your cash flow, disrupting your revenue cycle and making it challenging to meet financial obligations. Furthermore, chasing down debts can be a stressful, time-consuming task, especially if you lack the necessary resources to manage it efficiently.
Solution: Outsource Payment Reconciliation and Debt Collection Services
With a comprehensive revenue cycle management solution, you’ll have everything you need to stay on top of your account status and receive all the payments you are owed. You’ll be able to easily reconcile payments, access debt collection services, and track your receivables in real-time. This solution is designed to quickly identify any payment delays or discrepancies, ensuring you can focus on what you do best without worrying about the financial side.
Furthermore, debt collection services can help bring in some major cash flow if you’re struggling with overdue payments and outstanding debts. They can assist you in recovering the money you’re owed, which is especially beneficial if you don’t have the necessary resources or knowledge to handle debt collection on your own.
At Capital Recovery, we help healthcare organizations to streamline their billing process and help with insurance follow-ups and debt collection. We help establish a tight, efficient revenue cycle that improves your cash flow and bottom line. Call us at 470-297-1120 to talk to one of our experts and learn more about how we can help you.