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Common RCM Mistakes How to Avoid Them?
Common RCM Mistakes: How to avoid them?
Healthcare policies and changes are constantly changing. Therefore it's critical to use effective RCM (Revenue Cycle Management) tactics. Medical companies must streamline their administrative procedures to achieve financial results. A revenue cycle that isn't simplified might lead to frequent issues that every healthcare provider must cope with. An economically responsible medical billing and coding company must provide outstanding patient care while keeping track of its overall financial health. With ICD-10 codes and value-based compensation, a large amount of patient data must be handled for billing purposes. The increasing complexity of correct medical billing has been intensified by the changing pattern of patient payment structures. The following are the functions that make up a hospital's revenue cycle management:
- Documentation
- Entering the patient's demographic information
- Examining insurance claims for eligibility
- Medical coding and billing
- The claims are filed.
The following issues can develop if there is no smooth coordination between multiple units, such as the billing and coding department, data analytics department, collections department, and payer enrollment department:
- Non-clinical insurance claim denials that occur as a result of incorrect patient data entry during registration.
- Medical code documentation errors might result in insurance payment denial.
- Interoperability inconsistencies in patient-provider communication caused by a lack of digitization.
- Insufficient non-compliance with the Health Insurance Portability and Accountability HIPPA Act.
- Medical billing and coding businesses can assist in overcoming these issues by employing appropriate troubleshooting approaches. However, the problem is that healthcare facilities are unaware of these irregularities and continue to use traditional management methods.
- The lapses that healthcare facilities must avoid are listed below. These errors might have a negative impact on the revenue management cycle.
Lack of trained Employees
Medical billing and coding companies necessitate proper data collection. On the other hand, human mistakes could cause the rising frequency of claim denials at this stage. Unskilled employees submit incorrect ICD-10 and CPT codes for diagnosis and treatments offered. Claim denials might result from missing patient data items to wrong dates entered during chart writing. This means the healthcare provider will have to redo the claims, which will cause the reimbursement to be delayed.
Fragmented administrative staff
The front-end office's administrative role is to speed up claims processing by ensuring that the patient's identity, insurance provider, and other personal details are correctly documented. The clinical function focuses on the patient's treatment and healthcare information collection. However, they will not operate synchronously, and if there is no seamless workflow, claim denials will increase.
Relying on staff strength
It may be challenging to handle the increasing number of patients and accompanying data when healthcare institutions rely on existing workforce levels. It's critical to hire the right personnel with the correct qualifications. On the other hand, healthcare facilities attempt to maximize the capabilities of their available personnel. This has a negative impact on the revenue cycle's administrative and clinical activities.
Failure to keep track of the progress of a patient's medical claim
Healthcare practices do not focus on keeping track of the entire claims processing process. If potential claims problems are not identified, it can lead to a backlog of accounts receivable and high administrative expenditures.
Ignoring the patient's eligibility
Before administering therapy, medical billing and coding companies must take extra precautions to ensure that the patient is eligible. If the patient's insurance coverage is not cross-verified, the claim will be refused. To effectively manage the revenue cycle, it is necessary to assess patient eligibility.
Lack of new technologies and trends
Many healthcare facilities are stuck with outdated billing systems that aren't capable of handling massive amounts of patient data. The revenue cycle is complicated by the inability to simplify digital procedures. Hospitals may lack the adequate infrastructure or be constrained by financial constraints. Time, money, and effort are saved when innovative technology is integrated into healthcare institutions. As a result, the return on investment (ROI) improves.
Lack of proactive attitude to patient payments
As an outbound calling tactic, medical practices are hesitant to contact patients for their statements. Patients may require payment-related information. On the other hand, medical procedures can generate higher patient payments if they are approached aggressively and compassionately.
To avoid all these common mistakes, you should
Verification of Insurance Eligibility and Benefits
The majority of claim denials are caused by inaccurate insurance or coverage information. Verifying insurance eligibility and coverage data before the patient's appointment with the provider can help to reduce this. Verifying the following information can assist in identifying missing or incorrect coverage information and understanding coverage updates and modifications.
- Patient information and demographics
- Benefits according to the patient's plan
- Dates of implementation and termination should be planned.
- Deductibles, co-pays, and co-insurance
- Insurance coverage, both primary and secondary
- Benefits at the code level
- Limits on the amount of coverage for a specific operation
Audits of Coding
Coding is the most time-consuming and difficult process; coding errors may appear to be unavoidable. Regular coding audits will help the coder achieve accuracy and improve the overall health of the Coding Process by highlighting repeated errors, failures in following coding principles, and client-specific protocols.
Examine the AR Days
Analysis of delayed and denied claims and frequent follow-ups are required to ensure that claims are paid within 30 days to optimize collection and avoid claims in extended days or over 60 AR days. As we all know, the longer you work in AR, the less likely you are to get paid.
Amount Charged vs. Amount Paid
It's also crucial to understand the percentage of claims paid according to the charged amount or the fee schedule. Because low-paying claims can add up to a significant revenue loss, it's critical to analyze and appeals to the payer until the claims are entirely settled for good Revenue Cycle Management.
Write-offs as a Percentage
When examining your paid claims, keeping track of how much you had to write off will help you figure out where your money is going. If you are paid less than the agreed-upon amount, which results in most of your write-offs, you should look into ways to recover them or reduce them in future claims.
Percentage of Paid vs. Denied
On a weekly or monthly basis, it's critical to review your paid and refused claim percentage. This enables you to identify the areas that impact the quality of your revenue cycle management and take corrective action.
Certification of Physicians
Ensure that your physicians are certified, and credentials are renewed on schedule to optimize your overall Revenue Cycle Management. An insurance company must accredit your physicians to process your claims. Claims will be refused if the rendering physician certification is invalid. Keeping track of re-credentialing deadlines will help you prevent last-minute headaches that cost you money.
Using an offshore medical billing company to handle your RCM services
Offshore outsourcing for Revenue Cycle Management has long been recognized and accepted as the most acceptable option. With their expertise and experience handling the services for numerous clients, outsourcing your revenue cycle process to an offshore-based medical billing business will help manage all of the challenges described above. All of your RCM criteria outlined below can be met by a well-established Medical Billing Company:
- Enhanced cleaner Submission of a claim
- Excellent AR follow-up abilities to guarantee that claims are paid within 30 days of receipt.
- An in-depth audit procedure is conducted on each service scope and area requiring specific attention.
- Monthly Reports with Paid vs. Denied Claims Variation
- AR and Denial Management Follow-up Credentialing and Re-credentialing Expertise
Medical billing and coding companies must adapt to the changing healthcare landscape for effective revenue cycle management. Medical billing and coding services can help you stay on top of these changes by effectively managing the revenue cycle to increase profits. It's because accurate billing and coding are essential for reducing claim denials and laying the groundwork for efficient revenue cycle management.
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