According to a report by the Healthcare Financial Management Association (HFMA), in 2021, around 90% of the denied claims could be avoided. This part of the claim denials amounted to about $235 billion as annual revenue for the American medical industry. Given the various struggles that the healthcare systems have been facing since the pandemic, a more significant revenue loss could prove detrimental to the organization’s financial health. Lack of proper staff training and updated information could lead to these revenue cycle billing mistakes, which harm the performance of healthcare organizations.
While some health systems suffer from severe staff shortages, some struggle to keep their regular operations afloat. Many healthcare systems have also shut down their operations or merged with another larger entity to keep their presence going. Experts believe that hospitals and other health systems need proper guidance in their digital transformation journey to ensure that these problems are not repeated further. As 2021 comes to a close and several new regulations go into effect from 2022, here are a few revenue cycle billing mistakes that you must avoid.
Information Collection Procedure
- An incomplete and inappropriate data collection system is one of the most common reasons for claim denials.
- Claims need to be complete and without any errors to make sure that they are not denied or rejected. Getting a clean claim in the first go leads to better revenue flow.
- Information comes in from several quarters when it comes to filling up claim details. The foremost of the lot is which comes in from the patients.
- The revenue cycle billing process starts way before the patients undergo any treatment or procedure in the healthcare organization. The first step of the process is to collect sufficient and updated information from the patient during the onboarding process.
- Most of these issues occur when the patient data is fed in manually. Many healthcare organizations have shifted to automation software technology to ensure that none of the information is lost or left incomplete.
- Workflow management software used for the entire team can keep everyone in the same loop. Every member of the organization can access it according to the different authorization levels.
- Keeping the entire in-house billing team in a loop helps them stay updated on the status of the different tasks assigned to them. In the case of the patient data collection system, it can also help make the process more straightforward with a ready template.
Incomplete Provider Credentialing
- Incomplete provider credentialing harms the revenue cycle management of the healthcare organization and threatens the reputation of the organization.
- You need to have the detailed credentials of the providers in your organization in a properly integrated system so that you can access them at any time.
- They are also crucial when getting the providers enrolled in the insurance panel preferred by the organization or the group practice.
- However, provider credentialing is a cumbersome and stressful process. It is best handled by experts of this domain who know the system’s complexities.
- Several health systems struggle to complete the provider credentialing process within 120 days due to several incomplete data fields and several primary source verification issues.
- It would help if you had a strong team of competent professionals handling these details for you so that you do not miss out on revenue during this phase.
- Many leading revenue cycle management companies also offer customized software services apart from their usual professional services to simplify the process.
- Get in touch with an experienced RCM company to know about the kind of services they offer and complete your provider credentialing process within a short span to avoid delays in cash flow.
No Established Appeals Protocol
- The absence of an established appeals protocol could be one of the crucial reasons your appealed denial is not getting a positive response from the payer.
- The appeals process is not pretty simple, and it needs professional intervention if you want to recover your revenue flow from those claims.
- With healthcare organizations suffering from several issues with staff shortages, it can get quite tricky for them to decide on a proper protocol for appealing denied claims.
- Professional teams of billing experts have devised repeatable and scalable processes to improve the chances of recovering lost revenue.
- You can take the help of these teams from RCM companies to help you out with the process. They can train your staff with sufficient updated information and guidance on how to go for the step-by-step appealing procedure.
- If you are unsure of your situation in current times, then you can outsource the entire process to these professionals. Make a decision based on your financial health and your desired outcome.
To know how to write an appeals letter for a denied claim, you can read the article here.
Patient Eligibility Verification
- Most health systems do not have an established and simple method to verify the patient’s eligibility during the time of preparing the profile on their system.
- Patient eligibility verification is highly crucial for you to know if you can bill the patient’s healthcare insurer and how much the patients need to pay out of pocket.
- Surveys show that patients are more interested in knowing their out-of-pocket expenditures before undergoing the treatment.
- Lack of verification, in the beginning, could lead to denials during the claim submission period. At times, the patient can also have multiple insurers. You need to know which one to bill and which one of them covers the particular services.
- HFMA, in their report, has also emphasized that healthcare organizations should use all available resources in their hand to verify the eligibility of the patients.
- Any small clerical mistake such as a misspelled patient name or organization name could lead to a huge loss of revenue for the hospitals.
- You can opt for customized software systems offered by the leading RCM companies, which will tell you the details in a short span after you enter the patient details.
We hope this article helped you understand which revenue cycle billing mistakes you should avoid in 2022 and how you can rectify them. Please connect with us in the comment section below in case of any queries. Subscribe to our blog for regular articles on the medical billing industry. Follow us on Facebook, Instagram, Twitter, and LinkedIn for more.