A medical practice’s claims denials average a staggering 5 million dollars per provider annually. Tackling the causes of denials from the front end can help healthcare organizations reduce rejections, recover lost revenue, and increase the success rate of claims appeals.  

Outlining the Issues

Challenges in receiving timely payment for medical services can be attributed to not only reimbursement denials, but regulatory and economic changes that disrupt revenue streams and contribute to loss of practice income. Effective digital strategies and innovative approaches can help healthcare practitioners decrease their lost revenue and increase the organization’s financial success. 

Healthcare RCM

Reimbursement denials are often due to coding errors or incomplete documentation that can quickly lead to substantial revenue loss. Continuously shifting payer policies and regulatory requirements makes revenue management increasingly difficult. Economic changes, patient demographics, and the client’s availability of healthcare spending dollars add to the quagmire.

Maximizing and streamlining a healthcare’s claims operations is instrumental for practices to fully recover revenue and boost financial efficiency. Revenue Cycle Management (RCM) software is the solution. Virtual OfficeWare Healthcare Solutions offers RCM services, along with AdvancedMD cloud-based, all-in-one medical software for all roles of your practice that reduce time-consuming tasks and denial rates. With unmatched stability, security, and real-time access, their next-gen technologies automatically streamline administrative workflows, proactively identify, and resolve potential barriers leading to increased financial performance and practice growth.

Claims Denials Under Control

Claims denials management is a major part of healthcare revenue recovery. To reduce lost revenue, healthcare organizations must identify the cause of claims denials by reviewing patterns and trends in denied claims. Issues can be coding errors, insufficient documentation, or eligibility issues. 

Effective RCM in healthcare relies on a dependable process that includes multiple steps, from patient registration and appointment scheduling, to claims submission and reimbursement. Each of these stages presents opportunities for revenue optimization, and potential pitfalls that can hinder financial performance. KPIs (Key Performance Indicators) evaluate the efficiency and effectiveness of each claims stage, allowing organizations to identify barriers, and implement targeted improvements. 

Armed with this knowledge, practices can pivot to reduce future rejections. This process may include effective staff training programs to ensure compliance with changing payer requirements.  

Improve Operational Efficiency

Tracking KPIs enables organizations to identify inefficiencies and bottlenecks in revenue cycle processes. This allows for targeted interventions to improve operational efficiency. 

Enhance Patient Experience

Certain KPIs, such as patient satisfaction scores and billing transparency metrics, provides insights into the patient experience. This enables practices to make improvements that enhance patient satisfaction and loyalty. 

Value-Based Care Models 

Switching to a Value-based Care model prioritizes the quality and outcomes of patient care over the volume of services provided. By implementing value-based care initiatives healthcare providers can align claims processes with payer incentives to deliver cost-effective and high-quality patient care.  

Telehealth Services 

The optimization of telehealth services presents an opportunity for healthcare revenue recovery by providing virtual visits, remote monitoring, and additional telemedicine services. This not only increases access to patient care, but also allows providers to reach a broader range of their patient population, and potentially increase revenue.  

Offer Additional Services

Offering enhanced services including lab testing, durable medical equipment, and imaging can diversify revenue sources that help to stabilize cash flow and provide patient convenience. By investing in alternative revenue streams, healthcare organizations can reduce their dependence on fee-for-service reimbursement.

Improved Patient Financial Services

Clear, transparent co-pay and coverage patient communication, along with the availability of flexible payment options allows patients to make informed healthcare expense decisions. Healthcare providers should provide estimates of expected costs upfront and discuss potential financial obligations during the treatment planning process to help patients understand their financial responsibility and plan accordingly. Offering financial assistance programs, time of service payments, and financial plans for those struggling with medical bills can lighten the burden of healthcare expenses.

Deliver clear and itemized bills that outline the services in jargon free plain language, outline associated costs, and any applied adjustments or discounts. By providing patients with clear and accurate information about their bills, healthcare providers can reduce the likelihood of disputes and speed the payment process. 

Make Payments Convenient

In today’s digital world, user friendly payment options are essential for receiving timely payments and reducing accounts receivable. Healthcare organizations should consider offering multiple payment methods, including online portals, mobile apps, automated phone systems, and in-person payment options. By providing patients with payment options that fit their budget and preferences, healthcare providers can improve cash flow and reduce revenue loss.

Automate Reminders

With automated payment reminders and auto-recurring payment plans, patients can stay on track with their financial obligations and mitigate the risk of missed or late payments. 

Compliance and Regulatory Requirements

Ensuring compliance with regulatory and payer guidelines can reduce penalties and revenue loss. Healthcare organizations should stay current with regulatory changes, implement compliance programs, and conduct regular audits to identify areas of non-compliance to maintain revenue integrity.  

Optimize Resources

KPIs help healthcare organizations allocate resources effectively by identifying areas of underperformance, enabling informed decision-making and resource allocation. Additionally, they can work to develop pricing strategies for healthcare revenue improvement. Advanced analytics tools identify areas of revenue loss and provide improvement opportunities. By measuring key performance indicators (KPIs) for successful Revenue Cycle Management (RCM), healthcare organizations can boost their financial performance and increase operational efficiency whilst delivering an improved patient experience.

Time is Revenue

This KPI metric that measures the average number of days it takes for a healthcare organization to collect payments and complete the entire revenue cycle is important. The time it takes for a healthcare organization to complete the process from patient registration to final payment collection greatly impacts revenue collection.

Denial Rates Matter

A practice’s clean claim rate measures the percentage of claims that are submitted and processed without requiring additional information, resubmissions, and corrections. High clean claim rates reflect an efficient billing process and reduces the likelihood of payment delays or denials. First-pass claim rate measures the percentage of claims that are accepted by payers at the initial submission and gives feedback of billing process efficiency.

Monitor Account Aging and Collection Analysis

The longer unpaid medical claims remain outstanding, the more revenue is lost. Implement robust data collection processes for accurate and timely capture of relevant performance metrics. Leverage healthcare analytics tools and reporting systems to analyze data and generate actionable insights. Monitor performance and track progress, identify trends, and correct anomalies that require action.

Forming Strategic Partnerships

Technology partners create opportunities for healthcare revenue recovery. By making use of RCM expertise, healthcare organizations can achieve economies of scale and improve financial performance. 

Using data-driven insights to identify opportunities for optimization and implement targeted interventions to drive improvement is what we do. At Virtual OfficeWare (VOW), our expertise in operational efficiency, data analytics, patient engagement, and strategic solutions create a plan for your unique practice needs. Partnering today with VOW can unleash the power of automated tools that optimize efficiency, minimize claim denials, and enhance patient satisfaction. We have the right solutions to empower your revenue recovery today. Contact us to schedule a call back or schedule a free demo to see your future revenue recovery in action.