What You're Getting Wrong In Revenue Cycle Management (Part 2) | AdvancedMD

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What You’re Getting Wrong in Revenue Cycle Management (Part 2)

Revenue Cycle Management


In part one of this blog post we covered two important things you might be missing in your revenue cycle management. Here are two additional things to be aware of that could be causing you to lose out on revenue for your medical practice.

3: Assuming that revenue cycle management is done once you send a claim.

A common mistake that many providers and office managers make is assuming that your part of the revenue cycle ends when you send a claim for payment. While this often results in reimbursement by a payer, that is not a guarantee. The American Academy of Family Physicians (AAFP) reported that, on average, payers deny about 5% to 10% of claim submissions. A 2018 report from the Office of the Inspector General found that about 8% of Medicare Advantage claims are denied, while a Kaiser Family Foundation review of data reported by plans on the Affordable Care Act marketplace found that it can vary widely by payer, from 1% to as high as 40%.

Claims are denied for a variety of reasons. It could be as simple as missing information, an error in the insurance ID, or an incorrect Social Security number. In other cases a claim is denied because of a problem with coding or documentation, missing preauthorization, or the procedure isn’t covered by the patient’s plan.

A denied or rejected claim doesn’t always have to be written off. You can fix and resubmit claims with missing or incorrect information. You can also appeal claims denied for other reasons, but there is a deadline. That requires an adequate follow-up process to avoid leaving money on the table.

4: Not following up with patients for prompt payment.

Another common issue that could be negatively affecting your revenue cycle is a lack of follow-up with patients for outstanding balances. We know it’s difficult to talk about money, but it’s critical that you set an expectation with patients that they must promptly pay. Medical billing is complicated; you provide a service upfront and then have to bill for payment at a later time, which can lead to non-payment or late payments.

Some things that can improve your total patient collections include:

  • Providing an up-front estimate of the cost of a visit or procedure to set patient expectations. A 2016 survey found that 70 percent of patients who get an estimate are more likely to pay their bill.
  • Sending timely and frequent reminders via email, text, and mail to collect on unpaid invoices.
  • Offering flexible payment plans up front to help patients who might have otherwise ignored your invoice to pay it in small installments instead. If your current medical billing software doesn’t allow for payment plans, AdvancedMD can help.
  • Including a simple option for online bill pay with every text, email, or mailed statement.

Improve Your RCM Today

If your RCM isn’t cutting it, talk to AdvancedMD to find out more about our extensive suite of revenue cycle management software that can help you get things back on track.



Topic: Revenue Cycle Management


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