7-Step Plan for Mitigating Revenue Leakage

In today's dynamic healthcare landscape, the threat of revenue leakage looms large. This article offers specialized insights and strategies for revenue integrity officers, operations managers, and CFOs to navigate and conquer revenue cycle vulnerabilities. Dive in for expert guidance at every pivotal stage, from appointment scheduling to accounts receivable follow-up. You’ll gain important insights and actionable steps to ethically maximize your revenue capture and minimize your claim denials. 

7-Step Plan for Mitigating Revenue Leakage

Insights and Strategies for Every Stage

In the ever-changing landscape of healthcare, revenue leakage poses significant challenges to healthcare organizations' financial success. It’s crucial for revenue integrity officers, operations managers, and CFOs to recognize revenue cycle vulnerabilities and implement strategies to ethically maximize revenue capture, while reducing claim denials. This article delves into each step that may contribute to revenue loss, offering insights on mitigating leakage and optimizing revenue integrity.  

1. Appointment Scheduling 

The first step in revenue cycle management begins before the patient even sees the provider. When someone calls to schedule an appointment, it’s important to ensure that the provider's schedule is productive and realistic. Overbooking or inefficient scheduling can lead to lost revenue and impact the overall financial health of the practice. It’s also important to have a reminder schedule in place to ensure patients show up for their appointments. Missed appointments cost providers $200 per appointment, on average. This can add up quickly, as 27% of patients reported missing at least one appointment in the past year. (CVS Health Care Insights Study Report Executive Summary, 2022) Implementing clear policies for scheduling, billing for no-shows, and verifying insurance eligibility can significantly improve revenue capture in this stage.   

2. Registration 

Studies show a direct correlation between patient experience and profitability. In fact, positive patient experience is associated with increased profitability, while negative patient experience is even more strongly associated with decreased profitability. Notably, 64% of patients say they will likely switch providers if their expectations are not met (Accenture’s COVID-19 Consumer Health Experience Survey, 2020). Having front desk staff who can handle the registration process with care and efficiency and be pleasant with patients is not just important to the patient experience, it’s also important to ensuring optimal revenue.  This process includes gathering accurate patient information, verifying insurance coverage, and identifying previous medical visits within the last 12 months. Verifying insurance eligibility can be time-consuming, especially for larger practices, so exploring software options to streamline this process may save valuable time and resources.   

3. Render Services 

The success of your revenue is intricately linked to the performance of your clinical team. It hinges on essential elements such as maintaining adequate staffing levels, capturing billable services and supplies, and establishing effective patient recall systems. Accurate documentation of services, encompassing details like who performed them, the methods used, when they occurred, and where, is indispensable for accurate billing and reimbursement. And of course, prioritizing customer service and maintaining high data accuracy standards are also pivotal factors in this crucial stage.  

4. Charge Capture 

Charge capture involves accurately documenting and coding services provided. Staying up to date with coding rules and guidelines can be challenging, as they frequently change. According to a study by AAPC Services, 24% of claims are denied due to coding errors. Ensuring your coders are certified and knowledgeable will drive accurate coding, not only reducing the number of denied claims, but also freeing up your providers to prioritize patient care. Efficient charge capture processes, including utilizing EHR systems and automation software, can minimize errors and improve revenue capture. Many respected healthcare organizations leverage tools like Codify by AAPC to validate discrepancies between documentation and code selection, maximize clean claim rates, and ensure the whole team is operating at the highest level of efficiency.   

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5. Billing 

To ensure a steady and timely revenue stream, it's imperative to consistently submit claims, preferably on a daily basis. Utilize electronic submission for efficiency, as many payers now support electronic secondary claims. Monitoring and reconciling claims with payer reports is crucial to promptly address any lost claims. Having a technologically savvy biller to track claim statistics and perform reconciliations is vital. Hold this individual accountable for addressing any claims issues, emphasizing the critical role this function plays to your organization’s bottom line.  

6. Cash Management 

Timely and accurate posting of payments and explanation of benefits (EOB) is necessary. Utilizing electronic payment systems and maximizing electronic remittance advice (ERA) can streamline this process.  To ensure focused attention and operational efficiency, it's advisable to separate cash management from accounts receivable (AR) follow-up. When hiring for this role, prioritize candidates with exceptional data entry speed and accuracy. Regular quality assurance reviews will help prevent errors that could triple the workload in corrections. Additionally, incentivizing staff to keep a keen eye on key concerns, such as codes paid in full or a minimal percentage of the charge amount being paid, can lead to the early identification of revenue trends or concerns.  

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7. AR Follow Up 

Implementing a strengths-based or cost-based approach to your accounts receivable (AR) follow-up, depending on the size of the office, can improve AR outcomes. Specialized staff roles, such as insurance representatives and patient representatives, can streamline follow-up processes. Weekly scheduling and grouping similar tasks together can enhance productivity. And you can ensure ongoing success through regular reviews of the entire revenue cycle, targeted audits, continuous staff training, and staying updated on industry changes.   

Conclusion

Mitigating revenue leakage requires a comprehensive approach across all stages of the revenue cycle. By partnering with AAPC, an industry leader in revenue cycle management, your organization can leverage expertise in the front, middle, and back of the revenue cycle to identify revenue leakage, implement effective strategies, and achieve stronger financial outcomes.  

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