With proper revenue cycle management, medical practices could save $16.3 billion, or 42% of the $39 billion spent on administrative transactions, according to the Medical Group Management Association (MGMA).
Suppose you notice that other medical professionals perform much better than you while delivering the same healthcare services. In that case, something needs to be fixed with how you are invoicing and categorizing your patients’ medical expenses. Especially when your practice has begun to pick up the patient count and increase earnings following the epidemic, the only thing you want to do is overlook incidents like these.
To comprehend how to mitigate your practice’s income loss, you must be familiar with the causes of financial harm. This post will look at the top seven elements that affect your practice’s revenue once you’ve identified the ones you can focus on and optimize your revenue cycle.
To investigate the causes of revenue loss in your healthcare practice and devise a strategy to counteract it, you must first understand the factors that pave the way for such shortcomings. In this article, we will highlight six of the essential aspects that impact your practice’s revenue once you have determined the areas in which you can focus your attention and make improvements to your revenue cycle management.
Billing Rules Interpretation
There are undoubtedly valid billing regulations in the medical profession. However, different rules allow for alternative interpretations. When other methods of providing the same service generate different amounts of money, it may occasionally be the cause. Finding an outsourcing partner with billing expertise and knowledge of adhering to RAMQ requirements is the best action.
Correctly interpreting the guidelines is essential for professionals who want to prevent under or to overcharge their clients. Both circumstances can be troublesome since underbilling results in income loss while overbilling developments in an RMAQ investigation for your firm.
Credentialing and Enrollment Failure
Only a limited fraction of practices regularly need to update their credentials and promptly enroll any new providers. However, it has far-reaching consequences because practitioners who don’t comply face payment delays, claim denials, out-of-network treatments, and ultimately a drop-in revenue. As a result, every practice’s revenue management system must incorporate periodic updates of credentials and enrollment.
Financial Responsibility of the Patient
Recently, patient financial responsibility has increased as patients are being asked to pay an increasing amount out-of-pocket for their medical treatments. Additionally, the increased patient financial responsibility has made it more challenging for healthcare institutions to guarantee comprehensive and on-time collections. Lack of information and clarity regarding unforeseen expenditures and fees is one of the main reasons healthcare organizations frequently need help collecting from customers who owe money out of pocket. Healthcare organizations must create a medical billing system that is open, simple to comprehend, and clearly outlines all charges to patients to guarantee prompt payment of invoices for individually liable patients.
Missing or incorrect patient records
The collection of patient eligibility and insurance information marks the beginning of the RCM process, which continues throughout the patient’s relationship with the provider. However, complete or accurate data collection could ensure the processing of claims for reimbursement. To eliminate delays caused by missing or erroneous patient information, an effective and easily repeatable strategy for capturing and preserving patient records during the initial visit must be implemented.
Choosing the Correct Software
Although there are numerous options for medical billing software on the market, it is your responsibility to choose the best one. It is essential to have software that assists with billing optimization. For example, the software can inform you about missing billing data and update or replace the codes. Furthermore, adopting sophisticated and up-to-date software aids in the prevention of revenue losses. Any practice that does not comply with this is at a loss because it cannot reap the revenue system’s rewards.
Acknowledging Your Obligation
In medical practice, each specialty has an agreement and code of conduct governing its operations. Given the practice’s specific customizations, you must comprehend the contract and its terms. This agreement will include all contract changes, rules, and terms that apply automatically. If the company follows the terms of the deal, it could avoid losing money or paying hefty fines because it has more liability.
Conclusion
Each of these seven criteria can assist you in lessening the impact on your practice’s revenue. But one of the best ways to advance is to contract your medical coding and billing services to an experienced professional who can handle it all. At the same time, you focus on giving your patients the finest treatment possible. With a staff of experts at your service, Doctor Papers is one such outsourcing provider for all of your medical coding and billing requirements.
References
Billing Services, M. (2022, March 10). Top 7 Factors Affecting Your Practice’s Revenue – 24/7 Medical Billing Services. https://www.247medicalbillingservices.com/blog/top-7-factors-affecting-your-practices-revenue/
Which Factors Impact the Effectiveness and Efficiency of RCM? – Bikhamhealthcare: Provider Resources. (2021, November 19). https://www.bikhamhealthcare.com/provider-resources/which-factors-impact-the-effectiveness-and-efficiency-of-rcm/
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These six aspects affecting the management of your physician’s revenue cycle will provide you with a general sense of why your revenue cycle may incur a loss.