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Healthcare Revenue Cycle Management: What You're Doing Wrong and How to Fix It


Poor revenue cycle management (RCM) is a significant challenge in healthcare today for a number of different reasons. Studies estimate that up to 25-30 percent of medical practice income is lost due to improper billing practices—and that’s only one part of the problem. Along with creating financial challenges, poor healthcare RCM can also diminish the patient experience due to disorganization and a lack of communication.

Here are the most common healthcare revenue cycle management errors and how you can resolve them to maximize performance:

What You're Doing Wrong: Most Common Healthcare RCM Errors

To effectively improve and optimize your revenue cycle management, first you need to identify what you’re getting wrong. Start by auditing your current processes to pinpoint problem areas and identify low-hanging fruit opportunities for improvement.  

While the reasons behind poor healthcare revenue cycle management can vary, there are certain mistakes that tend to come up again and again, such as: 

Not Being Proactive

One of the most common mistakes in healthcare revenue cycle management is failure to be proactive. Waiting until a claim is either denied or underpaid in order to make corrections creates duplicate work and slows down the reimbursement process.

Lack of Technology

A lack of technology and automation is another common healthcare RCM error. Sticking with manual and paper-based processes rather than embracing automation technology is both time-intensive and error-prone—not to mention outdated.

Failing to Use Data

Failing to make smart use of financial data is another common revenue cycle management mistake. Not tracking your own internal key performance indicators or comparing them with external data makes it difficult to optimize and improve performance. 

Disjointed Staff

Disjointed departments are also problematic. Separate front- and back-end functions tend to create silos and gaps in the revenue cycle process. For example, failure to verify eligibility in advance of a patient’s appointment can create bad debt and a poor patient experience since they can end up with out-of-pocket costs they didn’t anticipate.

Poor Documentation

Then there’s generic or missing clinical documentation. Not ensuring accuracy in your clinical documentation slows down reimbursement. Plus, it can cost healthcare organizations thousands of dollars and create compliance risks.

How to Improve Your Healthcare Revenue Cycle Management

Even if your healthcare organization is making one of these mistakes, you can still improve your revenue cycle management with the right strategy. Here’s how:

Put in Upfront Work 

Putting in upfront work is important. It’s faster and cheaper to do the work on the front end rather than waiting to clean up claims on the back end after claim denials or underpayment. Make sure your staff is properly trained to ensure you’re using accurate coding, with checks and balances in place to minimize errors.

Get Prior Authorization

Always take the time to verify eligibility with each patient’s insurance company to determine the level of coverage and what the patient is responsible for before they come in for surgery. Then, you can work with patients before they come in to make that payment at the time of service, so you don't have to chase them down after the fact.

Leverage Real-Time Data 

Leverage real-time data and analytics to track performance, compare it with both internal and external benchmarks, and measure your business’s effectiveness. Additionally, tracking metrics and analyzing data will help to improve your profitability and streamline your operations by identifying areas for potential improvement.

Embrace Automation

Automation is your friend. Use technology to automate any manual and paper-based process to work more efficiently and improve your claims management as a whole. Plus, automation also helps to minimize human errors and the need for duplicate work.

Enlist Expert Support

If you’re overwhelmed just reading this blog post, there’s a good chance you need to enlist expert guidance to establish a healthy revenue cycle that’s properly managed. There are several benefits to outsourcing your healthcare revenue cycle management to experts such as Amblitel. For example, you can gain more control and greater visibility of your revenue cycle with access to better data insights.

Amblitel helps ASCs maximize their revenues and increase their profitability by eliminating inefficiencies, decreasing expenses, reducing complexities, and speeding up the entire revenue cycle process. Get in touch to talk about your goals and how we can help elevate your ASC’s profitability and performance.

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