7 Quick Fixes to Stop Revenue Leakage in Medical Billing

Revenue leakage is a major issue in healthcare, the silent thief of healthcare profits. A study by the AMA found that as much as 30% of healthcare revenue is lost due to billing and coding errors, inefficient processes, and uncollected payments.

This is just a loss of revenue, but it affects the capacity of a practice to invest in improved patient care, maintain employees, and expand.

The good news? Numerous areas of revenue leakage in medical billing can be sealed with quick and tactical solutions. 

By implementing these solutions, healthcare organizations can significantly improve their financial health and ensure they’re properly reimbursed for the vital services they provide.

We’ll discuss how to prevent revenue leakage and increase your revenue cycle management (RCM).

7 Fixes To Stop Revenue Loss in Medical Billing

1. Improve Charge Capture

Proper reimbursement is based on accurate and full capture of charges. Without documenting and charging for a service, the service is lost forever.

Checklist for Charge Capture Improvement:

• Provider Education – It is important to educate all clinical personnel to recognize the significance of detailed documentation of every service provided, whether it is a procedure, supply, or medication.
• Use Charge Sheets/ Templates – Adopt standardized charge sheets or electronic templates that require providers to perform a tick box selection of all billable services and modifiers.
• Reconcile Appointments and Charges – Compare the appointment schedule with the charges submitted on a regular basis in order to detect cases of missed services.
• Review Ancillary Services – Do not ignore the laboratory charges, imaging, and other ancillary services.
• Use a Charge Capture Audit – A sample of the patient encounters should be reviewed periodically to determine that all the billable services were captured.

2. Prevent Coding Errors

Misplaced medical coding is not a villain, but one of the major causes of revenue leakage and frequent billing mistakes in health care. Even insignificant errors can mean the rejection of claims or even underpayment.

Coding Errors Prevention Checklist:

• Invest in Certified Coders – Make sure that the staff that performs the coding is certified and attends continuing education to keep abreast with the current guidelines in coding (ICD-10, CPT, HCPCS).
• Adopt Coding Audits – Intensive or external coding audit should be done frequently to detect patterns of error and offer specific training.
• Use Coding Software – Use a powerful Coding Software that has live error and compliance notifications.
• Interdepartmental Communication – Create effective communication between coders and clinical personnel to help clear the ambiguity of documentation.
• Concentrate on Medical Necessity – Educate coders and providers to make sure that the medical necessity of services is documented.

3. Address Data Inaccuracies in Patients

Any mistake in patient demographics, insurance details, or eligibility can halt a clean claim, resulting in delays and rejections.

Fixing Patient Data Inaccuracies Checklist:

• Check Insurance on Each Visit – Introduce a strict policy that will ensure that the eligibility and benefits of the patient’s insurance are checked with each visit, not only with the first one.
• Gather Full Demographics – Make sure that the front desk personnel gather full patient demographic data (address, telephone, date of birth, etc.).
• Apply Real-Time Eligibility Tools – Incorporate systems that can be used to check insurance coverage in real time.
• Patient Portal Changes – Request patients to change their information using a secure patient portal.
• Conducting Data Audits – Audit the records of patients on a regular basis to ensure consistency and accuracy.

4. Enhance Denial Management

Denied claims are services that have been fulfilled, but not billed – a straight blow of revenue loss. An effective denial management plan is very important to the optimization steps of RCM.

Denial Management Strengthening Checklist

• Categorize Denials – Categorize denials by reason, payer, and provider to determine root causes.
• Dedicated Denial Team – Have a special team or person who does the denials follow-ups and appeals.
• Timely Requests – Timely requests appeal claims that are denied, and comply with payer deadlines.
• Identify Payer Trends – Trend analysis. This examines the trend of specific payers in order to mitigate systemic problems.
• Feedback Loop – Feedback to front-end workers and coders, depending on trends of denials, to avoid similar situations in the future.

Related: Revenue Cycle Management Strategies: How to Improve Efficiency and Reduce Denials

5. Track Underpayments

A claim can also be paid at a lower amount than the rate contracted to even when it is paid. These under-reimbursements tend to be invisible, which adds to the invisible healthcare reimbursement problems.

Underpayment Tracking Checklist:

• Contract Management System – Install a system to coordinate payer contracts and their schedules of fees.
• Automated Posting of Payment – Use software that automatically compares received payments to those contracted.
• Determine Variance Thresholds – Configured alerts on account payments that are less than a specific percentage of the expected value.
• Immediate Follow-Up – Designate personnel to research and uphold low payments.
• Payer Communication – Open channels of communication with payers on the issues of consistent underpayment.

6. Automate Claims Scrubbing

Review of claims manually is time-consuming and most likely to be subject to human error. Claims scrubbing can be automated, and through this, a large number of claims can be denied before they are even filed.

Automation Claims Scrubbing Checklist:

• Install Claims Scrubbing Software – Install software that automatically verifies claims for errors in coding, information, and medical necessity, and payer-specific regulations.
• Adjust Scrubbing Rules – Schedule the software to incorporate your own practice billing rules and frequent denial codes.

• Train Billing Staff – Train billing staff on how to read and respond to the alerts that the scrubbing tool presents.
• Review Scrubbing Reports – Check the scrubbing tool reports on a regular basis to determine the repeat problems.
• Integrate with EHR/PM – This is to ensure seamless integration with your Electronic Health Record (EHR) and Practice Management (PM) systems.

7. Perform Regular Audits

An audit checklist for medical billing is a must for the continued financial well-being. Periodic audits are useful in determining systemic issues and adherence.

Lists of Items to be audited:

• Planned Internal Audits – Have internal audits on billing procedures, coding, and documentation periodically every quarter or every two years.
• External Audits – It is advisable to have an independent audit by a third party regularly to have a fair opinion and a different view.
• Target High-Risk Areas – It is important to concentrate on the areas of audit that are prone to mistakes easily, or those areas that have financial implications.
• Review Compliance – Make sure your billing practices comply with all state and federal rules to avoid medical billing compliance errors.
• Actionable Feedback – Utilize the results of the audit to prepare correction action plans and give specific training.

Vozo RCM Service for your Medical Practice

At Vozo, we understand your struggle in navigating through all the revenue cycle processes, such as regulations, medical coding, and reimbursements. 

That’s why we bring the best cutting-edge service to optimize your revenue cycle management from start to finish. Here’s how Vozo can help you transform your practice’s financial performance.

• Automated tools for error-free coding and faster reimbursements
• User-friendly billing to keep patients satisfied and payments flowing
• Robust data security and compliance protocols to protect your practice
• Detailed reporting and analytics for smarter business decisions
• Solutions that grow alongside your evolving needs

With Vozo Revenue Cycle Management services, you can reduce the headaches associated with RCM and focus on what matters most is quality patient healthcare delivery.

“Partner with Vozo RCM Service and unlock the full potential of your healthcare practice and maximize its revenue”.