Authored by: Phallynn Espinoza
Losing significant revenue in your practice is possible, even when the signs are subtle. A slight increase in claim denials or a small trend toward more revenue slipping into the accounts receivable (AR) 120+ days bucket might seem like minor issues, but these changes can signal larger, more expensive problems—many of which stem from blind spots in your revenue cycle.
Understanding where to look for problems can provide visibility into the areas costing you money. After working with many practices over the years, here are the most common blind spots I see impacting health care revenue cycle management.
Viewing claims submission as the starting point of the revenue cycle
Where does the revenue cycle start? If you ask your staff, you’ll likely get many answers, with the most common being claims submission. However, I’d argue the revenue cycle starts much earlier—when a patient makes an appointment. By acknowledging this starting point and addressing issues that arise from it, you can solve many revenue challenges.
During that first call, you can find out the patient’s:
Deductible details. If the patient has met only $500 of a $4,000 deductible and has an appointment scheduled in two weeks, he or she likely won’t meet the deductible in that time. Therefore, it’s important to inform the patient of what’s owed and provide a way to pay it upfront.
Coverage issues. It’s surprising how often an existing patient makes a new appointment but doesn’t mention having changed insurance, which goes undetected until your billing team receives a claim denial. It’s much easier to ask about any changes when making the appointment, which allows you to proactively spot potential issues.
The challenge is that even if you know the above actions should be taken, implementing them isn’t always straightforward. You might have staffing issues or turnover that creates complications. The first step is establishing processes that help prevent these challenges, such as a simple checklist for the front desk to use when a patient makes an appointment.
Dirty data from manual processes
I’ve worked with practices that have a practice management software solution but lack a complete suite, including the billing solution. The challenge with this setup is that when the front and back office systems don’t “talk” to each other, you can end up with dirty data and lost revenue.
For example, imagine a patient calls to make an appointment, and the details are documented in the practice management system. The doctor uses a paper superbill to detail the visit, circling the relevant billing codes. With this setup, there are a couple of places where errors might occur, such as a practitioner not selecting all relevant codes or someone manually entering data and making mistakes. Both can lead to lost revenue.
If you had a complete EMR suite, with practice management, clinical documentation & billing, a biller would be able to potentially catch these mistakes, and data would be more likely to stay clean.
Lack of visibility and reporting capabilities
Large revenue problems don’t always start that way. They often begin as small issues in your revenue cycle that grow over time. That’s why reporting capabilities and clean data are important. They allow you to dig into the symptoms of revenue cycle problems to find the cause.
For example, you might notice an uptick in timely filing issues for your claims. What’s causing them? In this scenario, you might run different reports, such as one to determine how long it takes physicians to sign off on charts. Through this reporting, you might discover a time lag of weeks or even a month or longer. With this information, you can fix the problem and get your billing back on track.
You can also regularly run reports to see how much revenue is sitting in different AR categories—30 days, 60 days, 120 days, and so on. If numbers are high in the larger categories, you can dig into reports to find out why.
Mastering health care revenue cycle management starts with the basics
When learning any new skill, whether it’s a sport, a musical instrument, or something else, you start with learning fundamental techniques. With those fundamentals in place, everything else you build is stronger.
Effective medical revenue cycle management comes down to strengthening the fundamentals—knowing where the cycle starts and improving processes at that starting point, ensuring your data is clean, and using reporting to find and solve problems. Once you get the basics right, keeping your revenue cycle on track is much easier. And if you need help building those basics or solving any specific problems, we can help.