How Practices Can Avoid Overlooked Revenue Opportunities

August 28, 2023 - The impact of missed revenue opportunities has never felt more extreme, especially in today’s economy. The severity of rising healthcare costs has reached an unprecedented level. According to a recent MGMA poll, 90 percent of medical practices reported their costs have risen faster than their revenues, while only 10 percent said their revenues are keeping pace or ahead of rising costs.

As practices notice a change in their cash flow due to rising costs, overlooked revenue opportunities are also playing a large part in the potential decline. Undetected, these earned -- yet not collected -- revenue streams can affect profitability and majorly disrupt cash flow. By taking the time to identify these hidden revenue streams, healthcare practices can unlock potential financial gains and boost their overall revenue cycle. This article outlines common sources of overlooked revenue opportunities and strategies to solve them.

Delayed Billing Processes

A smooth and timely billing process is vital for optimized revenue streams. If charges are not sent out on time or rejections are not worked on immediately, practices risk losing revenue by not filing denials in a timely manner.

Practices should aim to process charges immediately and post payments promptly and accurately, as this affects when they can invoice patients. Late and inaccurate billing leads to unhappy patients and those late invoices can result in bills being prioritized from other vendors who billed patients punctually, causing payment delinquency for the tardy practice.

Carving out time to focus on streamlining billing processes to ensure accurate and timely filing can help guarantee practices seize all available revenue opportunities. It is important to post payments daily to confirm efficient handling of secondary billing, claim management, and denial management.

Ineffective Denial Management Workflows

Denial management is a crucial aspect of the revenue cycle, especially when the average cost to rework a claim is $25.20 per denial. If denial codes are not captured properly, practices will have difficulty creating the coordinating Follow Up Reason Codes (FURCs). Different denial codes have specific methods of work required for a resolution, so it is important practices develop workstreams for each FURC to ensure the denials are worked on effectively.

Without proper workflows, significant financial losses and operational inefficiencies can occur. An ineffective workflow may use quick fixes instead of addressing the root causes of denials. To fix this common roadblock, practices should categorize denials, attach the coordinating FURCs, and create a strict process to work more efficiently on denials. Once a process is in place, take the time to train staff to verify all denials are being handled properly and the proposed workflow has removed the kinks.

Insufficient Technology Optimization

Misused technology can have drastic effects on the management of one’s revenue cycle. Is the current system set up correctly to prompt logical workflow steps? If the system is not set up correctly to make processes seamless and consistent at the practice, it may create issues in billing processes, leading to areas of missed revenue opportunities.

To address these concerns, practices should partner with their technology vendor for a consultation on the most efficient and automated workflows for their system. Optimization leads to improved processes and seamless integration between billing, claim management, and denial management, ensuring a smoother information flow and minimized errors.

Decreased Patient Satisfaction

Delays or errors in patient billing, miscommunication, and lack of timely follow-up all impact the satisfaction of valued patients. If staff are not properly educated on all policies and procedures, the relationship between practice staff and patients can become strained. This tense relationship can bring about distrust and potentially lead to a high patient turnover rate and lost revenue.

To ensure patient satisfaction and to empower team members, regularly train staff on all policies and procedures and set a process for corrective action plans when an issue occurs. Consider taking it a step further by posting these policies in the office and communicating them with patients accordingly. By keeping patients satisfied with timely billing and excellent customer service, patients will feel at ease knowing their disputes will be handled accurately and any potential payment delays will be avoided.

Uncovering hidden revenue opportunities is a tough yet valuable undertaking. These missed opportunities can happen anywhere in the revenue cycle. By addressing these commonly overlooked revenue streams head-on, practices can improve their financial health and successfully put an end to overlooked revenue opportunities.

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Article Contributor: 

Marvin Luz, Senior Director, Revenue Advisory Services, Greenway Health