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Common Pitfalls You Can Avoid with Effective RCM

Posted By Giovanna Stahl
rcm services

Healthcare policies and reforms always seem to be in motion, especially in today’s political climate, making it a challenge for health care providers to keep up. If they can’t adapt to the changing landscape, they miss out on significant revenue. Because the healthcare industry is always shifting and evolving, it’s crucial that your facility’s revenue cycle management evolves with it to maintain cash flow. Implementing effective RCM can also help your facility avoid a variety of common pitfalls. Listed below are some typical drawbacks we would like to highlight for your close attention.

Claim Denials

One of the largest issues plaguing health care providers’ revenue cycle processes is the increasing amount of claims denials. Human error during medical coding processes accounts for a large number of claim denials. Often, undertrained staff members may select the wrong ICD-10 code while processing a claim, which leads to the claim being denied and means rework of the claim or the health care provider will not be reimbursed appropriately or at all for the patient’s treatment.

The recent increase in healthcare regulation has also led to more and more claims being denied. Insurance companies have been analyzing claims more closely, and organizations like Accountable Care Organizations (ACOs) have doubled down on efforts to reduce healthcare abuse or fraud. This closer inspection of claims, especially when paired with human error and improper ICD-10 coding, has led to a great increase in claim denials, which means health care providers, and their patients must pay for more medical treatments out of pocket.

It’s important that your staff monitors your facility’s claims process and identifies where errors are occurring as part of your revenue cycle management process.

Delayed or Missed Payments

More and more financial responsibility has fallen to patients receiving treatment in recent years. If this is because inaccurate medical coding leads to a denied claim, the patient may need to pay a hefty sum for treatment that should have been covered. However, even when coding errors haven’t been made, many patients have trouble paying for their treatment and will need to use credit or a payment plan.

Ideally, healthcare providers should collect patient payments before or immediately after treatment. This concept seems straightforward, but according to a study by Availity, some facilities have found it challenging to collect debts from patients without adding pressure and fear that may lead to dissatisfaction.

Health care providers should promote point-of-service payment collection as part of their RCM to avoid receiving delayed payments from patients. They should also educate patients to ensure they understand the necessary payment for their treatment and cut down on lost revenue.

Failing to Verify Patient Eligibility

Many healthcare providers don’t fully check a patient’s eligibility and insurance coverage prior to providing treatment. In fact, a study conducted by Caprio reported that 25% of practices never verify patient eligibility at all. When a provider doesn’t check a patient’s eligibility, there’s a greater chance that the claim will be denied, and the patient is left with an intimidating medical bill. As mentioned, if the provider doesn’t enforce point-of-service payment collection, the patient is likely to take longer to pay, or may dodge paying completely.

Checking patient eligibility during the pre-registration state is a key part of effective revenue cycle management. It’s crucial to verify your patient’s eligibility at the beginning of the process before they make their appointment, not later when you’re trying to bill them for payment.

Repeating the Same Errors

For facilities that see a lot of business and have many administrative tasks to keep track of, it’s easy for the same mistakes to occur repeatedly when processing claims. Putting a focus on and processing one claim at a time can keep your staff too close to an individual claim and miss over-arching patterns and errors that are affecting your claim approval rate. To fix this, it’s important that your facility monitors and reviews the entire claims process from beginning to end.

Revamping your revenue cycle management practices so that your facility performs this review will help your staff start to notice common patterns of errors in processing claims. Finding and stopping these errors can help reduce the number of claims that are denied, which in turn means more appropriate revenue for your facility.

Accurate Revenue Cycle Management is Essential

Accurate and effective revenue cycle management is an all-inclusive solution that can keep your facility ahead of the game in the ever-changing healthcare industry and earn your facility as much revenue as possible. To ensure your RCM can keep up with the changing times, you need to partner with an expert healthcare support service provider.

ECLAT Health Solutions can improve your RCM with Medical Coding, Medical Billing, Auditing, and Consulting services. We are proud to provide medical coding and billing services to healthcare providers across the U.S.with With our highly-trained team of medical coders, we can guarantee a score of 95% or higher coding accuracy in our work. We have a passion for helping your health care facility meet and exceed its revenue goals, even in our constantly evolving healthcare landscape.

Make sure your health care facility’s revenue cycle management can adapt and bring you as much revenue as possible. Learn more about our medical coding and billing services by calling us at (703) 665-4499, or filling out our contact form!

Tags: Coding, HIM, RCM, Revenue Cycle Management