When claims go unpaid for an extended period of time, healthcare CFOs must make the difficult decision to write them off. Delays in accounts receivable follow-up reduce the likelihood of being paid, so the speed of response of follow-up is critical.

While the revenue cycle team manages reimbursements, healthcare providers must focus on providing high-quality care. Hiring high-quality resources are critical as healthcare CFOs focus on implementing robust denial and A/R management processes. 

It can be difficult given the nation’s unprecedented labor shortage. Accounts receivable and denial management processes can be outsourced to a seasoned outsourced revenue cycle services provider to reduce revenue loss and improve financial outcomes.

Key Revenue Leakage Strategies in the Revenue Cycle

1 Structured Processes for Managing Denials Have Been Implemented

Rejection management is an essential procedure of human resource management services. Paying attention to clearinghouse rejections and RCM system alerts can save a lot of time and money. Furthermore, by using a 70:30 approach, RCM managers can enable their team to focus on the top 30 reasons that account for 70% of denials.

CFOs at hospitals and health systems can shift their focus to denial prevention by implementing processes that facilitate communication among clinicians, and front-end and mid-cycle team members. 

The revenue cycle team can eliminate many of the preventable causes of denials by reviewing the root cause of denials and focusing on eliminating the root cause through behavioral and systemic changes.

2 Outsourcing Your Revenue Cycle Processes Can Help You Improve Efficiency and Cut Costs

Outsourcing your practice audit and reporting services is used by healthcare leaders to gain access to denial management and coding talent. Seasoned service providers instill a culture of denial prevention by systematically removing the root causes of denials. Their data-driven approach can assist healthcare organizations in improving cash flow and reimbursements.

 

3 Revenue Leakage Costs Hospitals 3-5% Of Their Revenue

This is primarily due to ineffective clinical documentation and missed procedures. Expert medical coders collaborate with clinicians to address clinical documentation issues in order to reduce Discharges Not Fully Billed (DNFB). At the same time most hospitals have seen a significant increase in revenue after implementing periodic physician education programs.

In addition Revenue cycle processes that are efficient improve all business and financial outcomes, including patient experience, speed, and access to care. The most common reasons for claim denials are delays in physician credentialing, patient eligibility, benefit verification checks, and prior authorizations. A great RCM partner can help you resolve these issues and find the resources you require for other pressing needs.

 

4 Including Your Revenue Cycle Team

Revenue cycle management is a collaborative effort. Establish key performance indicators for all component processes throughout the revenue cycle’s front-end, mid-cycle, and back-end. These key performance indicators will assist you in measuring the efficiency and effectiveness of each component process. Involve your team members in reviewing the current state of these KPIs and developing a strategy for continuous improvement.

 

Conclusion

Medical billing company CFOs are shifting their focus to revenue growth by looking for ways to disrupt the status quo. Coordinated processes, collaborative team structures, efficient technology, effective measurement processes, and great partners.  Summary of revenue cycle leaders’ strategies for achieving dramatic improvements in the financial health of their healthcare organizations.

 

 

Read More: Healthcare Future and the role of medical coding.