Learn about the steps that providers need to take to improve their revenue cycle management process in 2021
A report by Healthcare Financial Management Association (HFMA) says, that about 90% of the claims denied last year were avoidable. The percentage when translated into figures stands at a mind boggling $235 billion. Some of the reasons attributed to the loss are inadequate staff training, lack of skilled resources and inability to stay abreast with updated information led to major revenue cycle billing mistakes. Much of these struggles have existed before the pandemic. But the pandemic, exacerbated these long prevailing struggles.
In 2022, much of these provider shortcomings are likely to continue. As the pandemic is likely to continue for some more time, providers will continue to struggle to keep their regular operations afloat. Therefore, this year, they need to take stringent measures to avoid a repeat in losses. The best ways to avoid this is by learning from the mistakes of 2021 and doing everything possible to repeat the mistakes. In this blog we look at some of the revenue cycle management mistakes that providers need to avoid in 2022.
RCM Mistakes You Need to Watch Out for in 2022
Improper Patient Data Collection
One of the most common reasons for claim denials is incomplete or incorrect data collection. This leads to errors in claim submissions. Therefore in 2022, providers must take all necessary steps to ensure that they have much-improved information collection procedure.
Healthcare information needed for filling claim forms come from diverse quarters. So, providers need to improve the process of collecting information across all quarters. The most important among these is the one that comes directly from patients.
The process of healthcare revenue cycle management kicks in long before patients walk in for the first interaction. This should be the first step towards collecting all the necessary and updated information. Any slip up here can have a direct impact on the revenue cycle management process. Such slip ups usually happen, when the patient data is fed into the system manually.
A proven way to capture information without error is by adopting modern-day technologies. One such technology is automation software technology. It automates the process of information capture and ensures none of the information is lost or left incomplete.
Likewise, embracing automated workflow management software can be great help to streamline the revenue cycle management process. The biggest advantage of such workflows is that it keeps everyone in the organization in the same loop. Every member can stay updated on the status of the tasks assigned to them.
Incomplete Provider Credentialing
The primary requirement for claims reimbursement is that the provider must be credentialed by the carrier. It is a process by which a health insurance carrier acknowledges a provider’s eligibility and competency in providing healthcare services.
Sometimes, provider credentialing stays incomplete with the carrier. Such a status can harm the revenue cycle management process anytime and lead to huge losses. This has been particularly the case with many providers in 2021. Therefore, in 2022, providers need to complete their credentialing with all payers.
Payers need detailed credentials of the providers to comply with regulatory requirements. They need to have them properly integrated into their system so that they can get access to it any time. It helps them get providers enrolled into the insurance panel preferred by an organization.
However, provider credentialing is a long and tiresome process. Only experts with experience in credentialing can handle the complexities. In fact, most health systems find it hard to complete the process within the stipulated 120 days because of varying requirements and many verification issues.
If your credential process is pending or has to be updated, this year you need to deploy competent credentialing professionals to complete it for you. Availing customized software services can also help to simplify the process. An easy way out is to get in touch with a medical revenue cycle management company to round off your credentialing process.
Absence of Established Appeals Protocol
In 2021, one of the many reasons for high denials was improper appeals. This was because most providers did not have an established appeals protocol to follow up for claims denial. Also, those with proper protocol could not implement it smoothly because of staff shortages. This impacted their revenue cycle management services.
The appeals process is quite complicated. It requires professionals to handle the process. Only those with complete knowledge of payer laws and regulatory bindings can assist you recover revenue that is on the brink of being lost. Therefore, to get access to the best appeals professionals, providers can seek the assistance of RCM companies.
RCM companies can assist you on two counts. Firstly, they have dedicated and specialized teams to handle appeals process. You can seek the support of these companies to set up an appeals protocol. Also, you can ask the specialists to train your staff on the appeals process. If handling in house is too taxing, then you can outsource the entire task to these specialized companies.
Improper Patient Eligibility Verification Process
In 2021, most healthcare providers did not have an established and straightforward method to verify patient eligibility. This is a mistake they need to avoid while preparing patient profiles in 2022. Patient eligibility verification helps you know if you can bill the patient’s healthcare insurer. Besides, it also helps you know exactly, how much the patient needs to pay out of pocket. Out-of-pockets is something patients are particularly interested in. Failing to let them know the exact amount upfront can lead to misgivings.
Verification is very important for yet another reason. Sometimes, patients can also have more than one insurer. So, you must know which insurer to bill. This again must be based on who provides coverage for the particular service. Therefore, lack of proper verification, at the onset, can lead to denials after claims submission. In fact, HFMA wants providers to tap into every available resource to verify patient eligibility to fortify their revenue cycle management process.
In 2022, providers must also move away from manual ways to verify patient eligibility. This is because manual process is open to errors. The smallest of mistakes including typos can lead to incorrect claims submissions that can lead to losses. Instead. providers must embrace customized software systems or automated solutions to verify patient eligibility. This will help them save on time, costs and most importantly, make the overall process 100% accurate.
Who We Are and What Makes Us an Authority?
MedBilling Experts is a healthcare BPO service provider with an excellent track record of supporting the back office need of providers. One of the services we specialize in is revenue cycle management. Over the years, we have partnered with several US-based hospitals and clinics to make their revenue cycle process more effective. We offer a comprehensive range of healthcare revenue management services. These include medical coding, medical billing, claims denial management and payment posting. We bank on professionals with vast exposure in rcm management, well-developed process and advanced software systems to deliver services. If you too are looking for best medical revenue cycle management services talk to us now.
