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4 Places to Look for Missing Revenue

Posted By Giovanna Stahl
revenue cycle process

Hospitals and other providers miss out on millions of dollars of revenue each year due to inefficient RCM practices. Between administration, billing, and coding, there are a lot of moving parts that, when working together, foster a healthy revenue cycle. However, this also means that when best practices are not used, or mistakes are made in any of these areas, revenue can be lost and may not always be easily or immediately detected.

For hospitals and providers that don’t love their bottom line, there are a few places they can look to track down that missing revenue. As medical coding, billing, and auditing experts, we are skilled at helping our clients and partners understand why they are missing out on crucial revenue, and how to recover it. With accurate coding, efficient billing, and expert clinical documentation improvement (CDI), we offer a variety of services that improve our clients’ revenue. We work as an extension of our clients’ practices, which allows us to explore and assess RCM errors on a deeper level.

Here, we provide insight into where facilities should look for missing revenue:


1. Clinical Documentation

Providers who struggle to identify the root cause of missing revenue should assess their clinical documentation processes. Every piece of clinical documentation must be as accurate, descriptive, and comprehensive as possible to ensure proper reimbursement. When a provider fills outpatient documents, they must describe the patient’s condition and requested treatment as accurately and thoroughly as possible. This description is used by coding staff to assign the proper ICD-10 code and process Medicare DRG or MS-DRG claims. Inaccurate documentation will lead to inaccurate code which, of course, leads to claim denials and delayed reimbursement.

ECLAT now offers clinical documentation improvement (CDI) services that ensure our clients do not miss out on revenue opportunities. We provide our clients with detailed, thorough feedback on their current documentation processes as well as concrete steps and solutions for improvement. We work closely with hospital CDI teams to generate the most accurate codes and DRGs, which translates to successful on-time reimbursement and increased revenue.


2. Patient Experience

When looking at their RCM practices and assessing how to improve, many facilities fail to factor patient experience into the equation. However, the experience a patient has at a facility, from signing in to receiving their treatment, to paying their bill and everything in between can all affect incoming revenue. High-quality patient experience was proven to greatly improve hospital revenue in one study conducted by Accenture. Providing superior customer service to patients affects their perception of a facility and will play a role in whether they return or seek out other providers for their next treatment. Further, a facility that offers transparent billing options and practices through their billing staff’s interactions with patients is likely to increase on-time payments. We discuss this a little further in the next section.


3. Billing & Collections Processes

Many healthcare facilities can find causes of missed revenue in their billing department. One common billing error comes from failing to collect payments at point-of-service. Availity conducted a study and discovered that a surprising number of facilities do not enforce POS collections and therefore either receive delayed payments or no payments at all, negatively affecting the health of their revenue cycle. In addition, facilities that do not take the necessary steps to communicate openly with patients and ensuring they understand their medical bills are more likely to suffer delayed payments. In the day-to-day of a busy physician’s office, simply handing a patient a bill is easy and convenient, but a patient who does not thoroughly understand their charge and how to make payments likely will not make them. For facilities with lower revenue, a deep look into current billing practices may provide some answers.


4. Quality Assurance Processes

Quality assurance is crucial for ensuring facilities maintain a healthy revenue flow. Using quality assurance processes will help a facility identify and avoid common causes of RCM mistakes such as coding errors, patient coverage inaccuracies, administrative errors, and claim denials before they can contribute to diminished revenue. Even further, quality assurance will allow a provider to identify patterns of errors in their revenue cycle and learn to avoid them in the future. ECLAT performs a 3-tier quality assurance process for each client to ensure accuracy and excellence at every step of the way. We perform this process with a 24-hour turnaround time for each case to give our clients the tools they need to earn and maintain higher revenue. Providers suffering decreased revenue should closely review their current quality assurance processes and search for ways to improve and earn better revenue flow.


At ECLAT, our medical coding and billing experts provide our clients with accurate, efficient services that help them improve their bottom lines. Not only do we identify causes of our clients’ missed revenue opportunities, but we provide suggestions and resources for helping them improve. Our comprehensive medical coding, billing, and CDI services all work to ensure our clients earn the highest revenue possible. We have found that facilities that take a deeper look at their current quality assurance, coding, and patient experience processes earn more revenue and a healthier revenue cycle.

Tags: HIM, RCM, Revenue Cycle Management