4 Reasons Why Your Medical Revenue Isn’t Being Optimized

Revenue from a medical patient is not collected immediately after an appointment is done and the patient walks out the door. Unfortunately, getting paid for a medical service is not so simple. The process starts from the moment a patient comes into contact with your practice, to the moment the service is completely paid.

Mistakes from Revenue Cycle Management

It is becoming increasingly difficult to manage revenue cycles for a medical practice. There are multiple aspects that contribute to proper medical revenue cycle management, including hiring diligent and organized staff members, collecting and verifying patient information in a timely manner, and reviewing third party payer contracts that also contribute to the gathering of revenue. It is not always a timely process. Your revenue may not be properly optimized if you are making these mistakes:

  1. Staff members at the reception desk do not collect all the right information at the first moment of contact with a patient scheduling an appointment. Patient records are crucial for providing medical care. The faster this is collected in whole, the faster revenue can be brought in. Your staff needs to avoid back-and-forth contact just to complete a simple patient record.
  2. Insurance eligibility is not verified before a patient’s appointment. Verifying coverage earlier on in the process will prevent rescheduled appointments later on.
  3. Payer contracts are not consistently reviewed. Losses could easily start piling up if your practice is not careful about following payer contracts. In addition, it is also imperative to make sure that you are being reimbursed the amount that is listed in your contract.
  4. Claims for reimbursement are declined. Claim denials are highly intertwined with eligibility and payer contracts. Again, this is all a process. When one step is done incorrectly, there is a domino effect of mistakes that extend the time it takes to take in revenue. Denied claims are responsible for up to 90% of missed revenue.

Medical Practice Solutions for Revenue Optimization

Here are some suggestions that can solve these mistakes and help get your medical revenue on the right cycle:

Training: Train your staff to know the right questions to ask. Keep all steps in mind at this stage. Insurance companies and 3rd party payers may need information that is forgotten at the moment that a patient is making an appointment.

Implement a policy on eligibility verification: As part of the training process, ask your receptionists to gather eligibility information as soon as possible.

Review payer contracts: Properly review payer contracts as soon as possible in the revenue cycle process. Look for holes in the contract that may be contributing to your losses.

File the right claims: Know how to file the right claims.

Outsource: By outsourcing revenue and practice management to a company like Applied Medical Systems, concerns like competency in the areas of insurance and the new ICD-10 coding transition are solved. The professionals at AMS are well-versed in all contributing areas of medical revenue, and our goal is to improve the time it takes for your practice to bring in revenue.

Contact us at our Durham, NC office to learn more about our practice management services. We serve practices all over the Triangle area.