Revenue leakage is nothing but the lost opportunity to collect money earned from your practice. The reason for revenue leakage can be rejected claims, unbilled claims, unbilled procedures, credentialing-related denials, underpayments, and outstanding patient balances. For any healthcare practice, medical billing and revenue leakages could result in significant loss because of long payment cycles.
There are notable loopholes in the overall medical billing process that should be monitored to ensure a steady cash flow, which will provide financial stability to your practice. In this article, we’ll outline the major issues of revenue leakage and outline our solutions to them in order to improve your practice collections.
Key Causes of Revenue Leakage in Medical Billing
1 Rejected Claims
The majority of claims are rejected due to wrong patient demographics and insurance details mentioned in the submitted claims. Claims will also get rejected if a patient changes their address or contact number with the insurance company and doesn’t update the provider’s office. Train your front desk staff to capture patient demographics and insurance details accurately while handling patients with care and empathy.
2. Unbilled Claims
Claims can remain unbilled or stuck in medical billing software due to scrubbing errors. Different medical billing software provides scrubbing features where the software will highlight errors in claims before submitting. Claims stuck due to scrubbing errors never reach the clearinghouse and can remain unbilled. Unbilled claims can be identified by comparing reports of patient’s appointments, procedures performed and the number of claims submitted.
3. Denied Claims
Denial management is a crucial step in revenue cycle management and requires to be handled with utmost expertise. Submitting an accurate claim is not sufficient, denial management will ensure that all submitted claims are getting paid and in case of denials, appeals with the appropriate documentation can be submitted. Hire a professional team who can resubmit denied claims, understand the reasons behind denials, and create a corrective process to prevent future denials due to the same issues.
4. Unbilled Procedures
Sometimes physicians leave some minor procedures unrecorded with the assumption that these are unbilled procedures. A detailed discussion between physicians and coders could help to distinguish between billed and unbilled procedures. You should have an expert medical coder in your team who can help to identify billed and unbilled procedures.
Educating physicians on billable procedures decreases instances of unbilled procedures and improves revenue. An expert medical coder usually helps to identify revenue leakage due to unbilled procedures after having a detailed discussion with the physician.
5. Credentialing-related Denials
Whether you are a small practice or a large healthcare organization, ignorance towards provider credentialing could become a prime source of revenue leakage. Ignorance towards non-participation of providers with certain health plans can increase denials. You should have a credentialing expert in your team who will handle evolving requirements and regulations related to provider credentialing and payer enrollment. This function is necessary to run a profitable practice and deliver quality patient care.
6. Underpayments
Most physicians are not aware of a fee schedule for various procedures. Different payers may pay you differently for the same procedure as per your contracting agreement. Underpayments can be avoided by planning and revising your fee schedule with various payers. At the time of contracting, it’s not mandatory to accept the payer’s fee schedule, you can negotiate. Seek expert assistance in payer contracting and in defining your fee schedules.
7. Outstanding Patient Balances
Your practice must build a seamless patient balance management process consisting of timely reminder calls/texts to patients, electronic payment methods, and flexible payment plans to ensure maximum reimbursements. Prior eligibility and benefits verification will state the patient’s insurance coverage, co-pays, or deductibles. You can collect more patient responsibility at the time of patient visits with a streamlined eligibility and benefits process.
Medical Billers and Coders (MBC) can help you implement effective RCM strategies to prevent revenue leakage and boost your practice’s financial health.
To learn more about how we can support your practice with expert billing solutions and revenue cycle management, reach out to us at: info@medicalbillersandcoders.com or call: 888-357-3226.
FAQs
1. What is revenue leakage in healthcare?
Revenue leakage is the lost opportunity to collect money earned due to issues like rejected claims, unbilled procedures, and underpayments.
2. Why do claims get rejected?
Claims are often rejected due to incorrect patient demographics or insurance details, like outdated address or contact information.
3. How can I prevent unbilled claims?
Regularly compare patient reports, procedures performed, and claims submitted to identify unbilled claims stuck in the system.
4. What causes credentialing-related denials?
Ignoring provider credentialing can lead to denials, especially when providers are not properly enrolled with certain health plans.
5. How can I reduce outstanding patient balances?
Build a seamless process for timely reminders, offer flexible payment plans, and verify eligibility and benefits to collect co-pays and deductibles upfront.
