4 RCM Pitfalls That Can Hold You Back From Collecting What You’re Owed

Healthcare RCM Pitfalls

Being owed money – regardless of whether you are running a small or enormous healthcare business, sucks! Constantly increasing bad debts and increasing days in medical accounts receivables can negatively impact your healthcare practice. Because physicians always need consistent cash flow to meet their basic medical expenses. So, without having streamlined revenue cycle management, they can’t keep their business running smoothly. A high rate of unpaid claims and a hefty amount of uncollected co-pays and deductibles are the major reasons. That holds medical practitioners back from achieving their revenue goals and make their business profitable.

Therefore, healthcare providers should never show negligence in managing their back-end administrative tasks i.e medical billing services. Because streamlined revenue collections management is one of the major factors that decide the financial and overall success of your business. But it has been observed that the majority of the healthcare providers are falling behind on their revenue goals. According to a recent estimate, physicians lose millions of dollars just because of unresolved claims. And medical claims get denied due to the loopholes in the negligence of registration staff and billers during data collection as well as claims preparation respectively.

However, if your billing collections are lower than your expectations. Then you must dive into the entire RCM process to uncover the areas of improvements. After identifying root causes that lead to revenue loss, you should implement smart solutions to fix the issues. No doubt, Making mistakes is human nature, none of us is exempt. But when it comes to managing financial matters, the physician should be very careful. Here are the following costly RCM mistakes that can leave your practice struggling with economic challenges.

1. Lack of a Defined Process

Billing glitches can occur in several areas of practice operations, especially during busy times. In some hospitals or healthcare facilities, there is no standardized process for both front desks as well as back end tasks. Which ultimately results in expensive billing mistakes. In addition to this, the lack of professional billers and coders is another major reason behind claim denials. Because the latest reforms in terms of billing and coding guidelines have made the RCM process extremely complicated. Without the assistance of experts, who can manage the medical claims efficiently, you can’t keep your denial rate minimal. In order to uproot the billing mistakes, physicians must standardize their billing processes as a “cycle”. That is supported by the highly trained staff.

2. Neglecting Critical Information

Failure to collect and store accurate patients’ information in a standard form could land healthcare providers in serious troubles. The demographic information on claims can result in claim denials and hold medical practitioners back from getting reimbursed. Missing or wrongly filled fields such as patients’ birthdate, complete address, name, gender, age, name of insured, phone number, social security number, insurance ID, etc, can delay the processing of a claim.

Furthermore, lack of prior authorization or invalid insurance information is among the most common reasons that leave medical claims unresolved. Additionally, insufficient medical documentation i.e. misstating the number of nights patients stayed at the hospital, or wrong details about the treatment can negatively impact your revenue collections.

3. Coding Errors

ICD-10 adaptation is sending massive waves throughout the medical industry. Embracing this coding transition requires in-depth knowledge and expertise. However, physicians, relying on administrative staff, having zero to little experience in medical coding are seeing more coding errors. The use of incorrect codes to describe the diagnosis, treatments, equipment or medical services is among the expensive RCM mistakes.

Coding mistakes are not only the major reasons for financial loss. But also can put your healthcare practice at legal risk. Because some coding mistakes like; unbundling, under coding, upcoding is considered as healthcare frauds. And leads to heavy fines and strict federal penalties. The most common coding errors are including:

Diagnosis and Treatment Mismatch
Medical claims containing contradictory information such as; diagnosis codes don’t match with procedural codes, usually get denied or rejected.

Upcoding/Undercoding
Both practices are highly illegal. Upcoding occurs when coders use the medical codes for the more expensive treatments than actually performed. Most of the time, healthcare providers are deliberately involved in this malpractice in order to increase revenue collections. Meanwhile, under coding happens, when claims are being processed with less expensive healthcare services than actual.

Unbundling
This occurs when physicians charge medical services as separate on a bill when they actually fall under the same medical code.

Delaying Your Claims Submissions

As we all know, every insurance agency has its own time frame for the submission of medical claims. Physicians, fail to file the claims within the given time window usually lose the payments for a particular time period.

Tips to Avoid Costly Billing Mistakes

Does unpredictable revenue loss become a major growth obstacle for your healthcare practice? Then don’t worry. Below are the following solutions that can help you to get your revenue cycle management back on the right track.

Automate Medical Documentation
If you are still using the manual methods to collect patients’ information and keep their medical history on paper. Then you must implement smart automatic solutions to increase the accuracy and efficiency of your clinical documents. Because orthodox methods always leave a huge room for errors.

For instance, the implementation of Electronic Health Records is the best way to keep medical records in a digital form. EHRs can improve the overall efficacy of your practice in the following ways:

  • Provides accurate, up-to-date, and complete information at the point of claims preparations.
  • Enable health care providers to access and share the healthcare data in a secured manner.
  • Bridge the communication gap between medical providers and patients.

Claims Scrubbing
In order to increase the claims first pass acceptance ratio, healthcare providers must have an efficient claims scrubbing process in place. They should make sure that medical billers are double-checking the claims to catch the potential errors. That can later lead to the claim denials.

The benefits of claims scrubbing include:

  • A high percentage of clean medical claims.
  • Prevents claim denials.
  • Faster payment.
  • Streamlined cash flow.

File Claims Electronically
Medical claims being submitted electronically to the payers are processed quickly as compared to paper claims. You should opt to automate the claims filing process as much as possible by using cutting-edge software. In this way, you can eliminate human errors and submit the medical claims before expiring the filing limits.

Acquire the Assistance of Experts
Dealing with the growing complexities of medical billing and coding isn’t a cup of tea. It requires particular skills and experience. So, healthcare providers should acquire the services of medical billing and coding specialists.

However, if you find managing the in-house RCM department costly. Then outsourcing medical billing services is the best option for the financial growth of your business. Outsourced RCM specialists provide customized solutions to unleash the profits that were locked in the inefficient billing system.

Looking for more tips to streamline the coding and billing process? Then stay tuned with the Medical Billing Benefits. It’s the most authentic healthcare news wire, that keeps you up-to-date about the latest reforms in the medical industry. To get detailed information, subscribe to our Newsletter.

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