The healthcare revenue cycle is multifaceted and complex, therefore causing many medical facilities and operations to overlook prime opportunities to enhance RCM. With awareness of such revenue possibilities, hospitals and other healthcare providers can maximize their profitability at every transaction.
Here, we will uncover the top opportunities to build healthcare revenue; coming from a range of sources, they include, benefit verification, scheduling and pre-registration, claims denials, charge capture, claims management, and monitoring issues.
Overlooking benefit verification is an easy way for an organization to miss potential revenue. A financial clearance process, benefit verification is based on the services offered to a patient after they are scheduled, such as coverage percentages, co-pays, deductibles, and charges for uninsured procedures. These components must all be individually verified before a provider can treat a patient.
Missing or incorrect verifications can cause not only delay medical care but potentially create claim denials and lost revenue for a facility. Facilities should request information from insurers about covered services, as well as quotes for those services. Electronic tools can help institutions determine the medical necessity of treatments, which avoids many claim denials.
Scheduling and Registration
Missed revenue can also occur from scheduling and registration discrepancies, even during the initial contact between patient and provider. A clear pre-registration process will clarify the financial obligations for treatment to patients beforehand. Any out-of-pocket expenses, such as co-pays and deductibles, should be collected before the procedure.
Streamlining the process further requires healthcare facilities to identify charity care cases up front, as to not waste time trying to manage unattainable revenues. Misunderstandings during this process can result in missed appointments or unforeseen schedule changes, both of which can result in lost revenue for a healthcare facility.
While many providers are aware of the revenue lost on denied insurance claims, denials are challenging to predict and eliminate. However, when claim denials do occur, forward-thinking facilities will track them by medical services, physicians, and staff services. Collecting and analyzing the total number of denied claims can be useful, but determining the origin of said denials can be even more beneficial long-term. A pattern of denials may indicate breakdowns in facility processes, which, one aware of, providers can fix. Interpreting payer contacts correctly and educating staff to handle denials are two strategies a facility can use to reduce the overall number of insurance rejections, and ultimately boost an institutions revenue.
Maximizing Charge Capture Opportunities
Suspense time, or the regulative timelines imposed on medical departments to enter charges after services are rendered, must be monitored carefully to optimize revenue captures. If suspense times are exceeded, a facility risks slowing their cash flow and thus disrupting their revenue cycle. Medical accounting staff should review the chargemaster systematically, to ensure all revenue is correctly captured and to record any adjustments. Accurately entering charges mitigates the chance of losing revenue.
The Claims Process
Claim denials, as mentioned before, are a common reason for lost revenue in healthcare facilities. Although they comprise a relatively small fraction of total claims, claims denials issue a large majority of missed revenue. Similar to suspense times, many insurers have deadlines for claims submissions. Write-offs must be monitored, and claims must be complete. Even if a form is filled in thoroughly with the correct information, minor mistakes in insurance claims can elicit denials, and waste time for both the insurer and medical provider.
Careful monitorization of the revenue process is critical to minimizing lost revenue opportunities. Healthcare facilities should be committed to organizing and continually managing their revenue cycle, but also be aware that some revenue goals will not be met as perceived. In that case, facilities should refine and restructure their accounting processes to position their cycle for future success. Adaptability to new technologies and changes in the healthcare industry is vital for a hospital to continue accruing revenue.
Utilizing electronic tools to manage the areas most prone to losing revenue can be extremely beneficial to a medical facility. eReceivables offers a suite of software products specifically designed to monitor the healthcare revenue cycle, along with additional services to boost practice efficiency; ranging from administrative management to operations. Preparing for and controlling potential areas to lose revenue with cutting-edge tools or forward-thinking administration can ultimately help the healthcare providers better their revenue cycle management processes.