7 Mistakes in Medical Billing and How They Impact RCM

Effective revenue cycle management (RCM) in medical billing is beyond essential for maintaining the financial health of ASCs. However, a mismanaged revenue cycle rife with process gaps can negatively impact an ASC’s bottom line and keep facilities from optimizing financial performance.

In this article, we’ll cover some of the most common medical billing mistakes for ASCs, how they impact financial performance, and steps you can take to minimize RCM mishaps. 

7 Common RCM Mistakes in Medical Billing

There are a variety of RCM mistakes that can be made in medical billing. Here are seven of the most common: 

1. Inaccurate Medical Bill Coding

Inaccurate coding is one of the most prominent mistakes in medical billing for many reasons, from varying education levels to changing standards. Typical medical bill coding errors include:

• Not entering the right billing code
• Using the wrong billing modifiers
• Putting codes in the wrong order
• Not coding for payable supplies
• Failing to code at the highest level
• Having discrepancies with the surgeon

2. Poor Payer Contracting

ASCs with inadequate or poorly managed payer contracts tend to experience damage to financial performance—especially when members of the RCM team don’t understand said contract’s negotiated terms. Payer contracts usually contain several nuances, and failure to comprehend what those really mean can put ASCs at a disadvantage during negotiations.

3. Failure to Verify Eligibility

Failure to verify claim eligibility before the date of a patient’s surgery can cause significant reimbursement delays and impede a facility’s cash flow—not to mention create a less-than-stellar experience for patients. Prior to the date of surgery, ASC staff should verify eligibility with the payer to properly understand coverage and obtain any necessary authorizations for the planned procedure.

4. Incomplete Documentation

There’s a common saying in healthcare: If it wasn’t documented, it didn’t happen. Incomplete patient information is a common barrier to accurate coding and billing, often causing lengthy reimbursement delays for ASCs. Even if the coding itself is accurate, you can certainly run into problems if the documentation isn’t there to back it up.

5. Slow Appeals Process

Not ensuring a timely appeals process for incorrect or rejected payments can greatly hinder a facility’s financial performance. Timely appeals follow-up is essential to improve your facility’s collections, A/R aging, and other key performance indicators (KPIs) indicative of your financial stability.

6. Failure to Monitor KPIs

Failure to track revenue cycle performance through internal and external benchmarks is a missed opportunity to identify low-hanging fruit opportunities to maximize revenue cycle management. If you’re not tracking your KPIs and comparing them with both competitors and your own past performance, how can you spot areas to drive improvements?

7. Unreconciled Medical Bills

Unreconciled medical billing is another common pain point associated with a mismanaged revenue cycle. Surgical centers leaving money on the table are essentially missing out on the chance to significantly boost profitability, enhance financial performance, and optimize the RCM function to be more successful.

Advantages of Outsourcing Your Medical Billing RCM

Outsourcing your medical billing and coding to certified ASC coders and experts in revenue cycle management can help provide you with peace of mind regarding your facility’s financial performance. Gaining increased visibility into all aspects of the billing processes reduces the risk of coding and documentation errors and ensures ASCs are capitalizing on all opportunities to improve.

Additionally, outsourcing to experts can help you compare KPIs with internal and external financial benchmarks, assure data integrity and continual process improvement, address denials and resolve issues causing payment delays, eliminate medical billing inefficiencies and the need for support from multiple vendors, and ultimately optimize RCM for greater efficiency and cost-effectiveness.

Curious about the benefits of outsourcing your facility’s RCM to minimize mistakes and maximize opportunities? Get in touch with Amblitel to learn how we can help elevate your ASC’s revenue cycle management and overall financial performance.