3 Revenue Cycle Management Mistakes that Drain Revenue

Healthcare organizations have various metrics that help define and measure success. With so many moving parts, how do you determine what to prioritize?

A strong and efficient revenue cycle is the cornerstone of your organization, so it’s important to start there. It is responsible for paying salaries, buying new equipment and even keeping the lights on.

Are you making the most of your revenue opportunities? Below are three common mistakes that compromise cash flow, and what you can do now to correct them.

  1. Failing to verify eligibility before providing care

Ideally, providers would prefer to verify eligibility for every patient before they receive care. In the real world, this isn’t always possible. Many things can prevent prior authorizations, ranging from unforeseen emergencies to a busy day in the front office that simply doesn’t allow the time.

While you can’t eliminate emergencies, there are ways to cut down on the mountains of paperwork facing your office staff. How many administrative tasks are performed manually? And of those that are electronic, how many different screens do they have to log into to confirm eligibility for just one patient?

Electronic claims management saves a substantial amount of time by enabling batch inquiries and alerts to indicate additional coverage for Medicare beneficiaries. You can verify eligibility for more patients in less time without rejected claims headaches after the fact.

  1. Operating with a fragmented claims management workflow

Speaking of claims, is there anything that requires more time and attention than managing multiple claims with multiple payers? From unique business rules to confusing rejection codes, claims management is usually fraught with long A/R cycles and time lost trying to locate and manage missing claims.

Make your claims submission process more efficient from start to finish with ABILITY EASE® All Payer. With a single platform, you can manage CMS and all other commercial payer claims, verify claims against the most current business rules (as well as customize unique rules for specific payers), and even address eligibility issues up front, prior to claim submission. Most importantly, you can achieve acceptance rates of up to 98 percent.

When rejections do happen, the claim immediately returns to your work queue with a clear message about the correction needed. No more trying to decipher confusing codes while your A/R days pile up.

  1. Writing off denied, low-value claims

In the hustle and bustle of a busy workday, it’s not surprising that low-value, rejected claims become the lowest priority. Billers are stretched thin and their time is better spent working on new, possibly higher-value, claims. But it shouldn’t come down to one or the other. Using the right technology, your staff can successfully handle all types and give a needed boost to a sluggish revenue cycle.

If you don’t find time to settle all of your claims, you aren’t collecting all the revenue you’ve earned. These “low-value” claims add up over time, so what seems like a reasonable write off could result in the loss of thousands of dollars. Not taking the time to resubmit these claims also contributes to poor A/R performance and patient frustration.

Some simple steps you can take to address this issue include:

  • Have staff verify coverage and eligibility prior to treatment
  • Use historical patient data to create new claims
  • Track claims from submittal through payment

The single best thing you can do to strengthen your revenue cycle is to prevent as many rejected claims as possible. This is where electronic claims management systems can have a huge impact.

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