Is your healthcare practice having issues with billing and collections? Are you unclear about why claims are getting denied or why you’re not collecting as much or as quickly as you were expecting? Just like a human body system needs all parts functioning to run smoothly, the revenue cycle needs all steps to operate smoothly as well for your practice to collect in a timely manner. Here are some parts of the cycle to evaluate and assess why you’re having trouble with collections.

Incorrect or Incomplete Patient Information

One of the first steps of the revenue management cycle is patient pre-registration and eligibility checks. This is the step in the process where your facility verifies patient information from their full name, date of birth, medical history and other health information to checking insurance information. All of this is important when filing claims with insurance companies.

If you do not have all the information needed, such as the patient’s insurance information, then taking time to find this information could affect your billing cycle. Or, for example, patient information could be entered or interpreted incorrectly. Perhaps there is a typo in the patient’s files. This could also lead to billing and collections inefficiencies.

These inaccuracies could be due to many situations. Maybe the patient is entering their information by hand and their handwriting was unclear. Or, perhaps there was no information entered for something that is later required when filing insurance claims. By having a consistent patient pre-registration process outlined and followed by all staff, your practice could avoid having to take time and find missing or incorrect patient information.

Using incorrect codes

Another reason that could be negatively impacting your revenue cycle is the use of incorrect or outdated codes. Each year CPT (procedure codes) are updated and used. ICD (diagnosis codes) are also updated. The newest ICD-11 comes into effect January 1, 2022. Having any codes or modifiers that are incorrect will result in denied claims which will then take more time to re-process and collect payments.

Ensure that coding and billing staff are updated on these changes and develop a process to avoid mistakes in coding. We’ve provided some useful resources here to stay updated on any changes in the coding and billing process.

Not billing in a timely manner

Another common issue that practices face occurs in the billing and claim submission steps of the revenue cycle. This is a constantly occurring process especially if your facility is seeing many patients. And it is a crucial step as well. It is probably no surprise to you that billing and submitting claims takes time. It takes time to prepare the claims and the correct procedure codes, but it also takes time for insurance companies to decide on payment.

Any step along the way could have issues arise such as lost paperwork, incomplete patient information we as mentioned before, or denials from the insurance company. If any issues occur, it will take longer that you expect to receive payment on those claims. This could significantly impact the timeline you had in mind for collections.

To minimize these issues, again, make sure your claims are being submitted properly, make sure you have all the patient information ready, and make sure your team has a detailed billing schedule in place, so claims are being submitted in a timely manner.

Timely Follow ups and Appeals

After claims submitting claims, sometimes there are denials. As with timely claim submissions, ensure that follows up and appeals are made in a timely manner as well. It can take time to gather the correct documents and re-verify information for appeals. As well, sometimes claims can go unpaid for a while without anyone knowing because follow-ups were not done.

If you have all the correct information for billing the first time, denials should be infrequent. Make sure your team follows up in a timely manner, and if denials do occur, ensure that appeals are also completed in a timely-manner to decrease the time between claim re-submissions and collections. It could also help to have an alert system to remind staff to follow up on claims or to have an automated denial processes put in place.

Americare Network

These are some common issues that can arise and affect your healthcare practice’s revenue management. By evaluating each step of the revenue cycle, you can become more aware of where inefficiencies occur and work to improve in those areas. If your practice needs help with medical billing, you can contact us today to learn more about our services. We cover a wide range of facilities across the United States and are here to help with your medical billing and collections needs.