Top 5 Revenue Cycle Management Challenges and How to Fix Them

Having trouble getting paid for the healthcare services you provide? You’re not alone. When it comes to revenue cycle management (RMC), many hospitals and dental practices experience challenges. Revenue cycle management is present in patient care throughout the financial portions of scheduling, and registration and ends with final payment.

Whether a practice is looking for a revenue cycle management solution or seeking additional tools as the standard of practice, this blog aims to provide that assistance.

Challenge #1: Inaccurate or Incomplete Patient Information

The Problem: While it seems trivial, erroneous patient data – such as incorrect insurance information or incomplete contact details- does occur more than you think. These errors cause claim rejections and slow down the payment process.

The Fix:

• Double-Check Everything: You should always double-check the information of your patients at every level (registration, Eligibility verification, claim submission).
• Use Technology: Many health centers already use electronic health records (EHR) to help collect information in a more streamlined, efficient, and accurate manner.
• Train Your Staff: Ensure your staff is well versed on why the correct collection of patient data is important and how to perform it accurately.

Challenge #2: Coding Errors

The Problem: Medical coding is complex. Wrong codes lead to denied claims and lost revenue. It may further result in compliance problems if not taken seriously.

The Fix:

• Keep Training: Regular training, especially for the coding team. Medical coding rules and guidelines also keep on changing so being up to date is very important.
• Utilizing Coding Software – There are specific software that can help you catch the errors and help you code your claims right.
• Conduct Audits: Regular audits of your coding practices can aid in spotting areas you need to work on.

Challenge #3: Claim Denials

The Problem: A denied claim is what an insurance company says when it refuses to pay a bill. There are numerous reasons why a claim may be denied, but one of the most common is coding errors.

The Fix:

Monitor Denials: Monitor your denial rate and reasons for denials. This will allow you to identify areas of improvement and potential improvements.

Outsource claims to a Claim Denials Management Company: Several agencies are experts in appealing claim denials on behalf of healthcare providers.

Claim automation: Software can receive and process claims with no human intervention. It can be useful for limiting the number of mistakes that are made, which in turn speeds up how quickly you get your claim.

We can see clearly in the below table that claim denial is a major challenge for all healthcare providers

Statistic	Commercial Payers	Medicare
Initial Denial Rate (Inpatient/Outpatient)	15.10%	3.90%
Prior Authorization/Precertification Denial Rate (Inpatient)	3.20%	0.20%
Request for Information (RFI) Denial Rate	4.80%	0.40%
Unpaid Claims After 3 Months (Inpatient/Outpatient)	Over 30%	Over 10%

 

Challenge #4: Inefficient Processes

The Problem: Slow or inefficient RCM processes can also mean delays in payments, escalating costs, and staff frustration.

The Fix:

• Map Your Processes: Make a flow chart that maps out your existing RCM processes, and then try to find areas that could potentially make them better.
• Automate: As much as possible, automate tasks from eligibility verification and claims submission to payment posting.
• Outsource work: If you lack the capabilities of managing RCM processes on your own, consider outsourcing services to another revenue cycle management company.

Challenge #5: Lack of Visibility

The Problem: If you don’t have a clear view of your RCM performance, it’s difficult to identify problems and make improvements.

The Fix:

• Use Analytics: Use analytics to track denial rates, days in receivables outstanding, and average reimbursement. This will keep you aware of the trends as well as areas for improvement.
• Invest in RCM Software: Another suggestion is to invest in RCM Software to provide you with a real-time picture experience of your financial performance.
• Get Expert Help: If you are unaware of how to track your RCM performance, get a consultant on board or partner up with experienced RCM companies.

In Conclusion

Revenue cycle management should not be a never-ending nightmare. But when you address these common hurdles, your financial performance will get better. Which will help you focus on what matters — the kind of patient care that gets people talking. Remember, help is available. There are solutions available to help you whether it is through technology, staff training, or partnering with an RCM company.

Your RCM process will benefit from Capline’s expert assistance by reducing denials and positively affecting your bottom line. Reach out for a free consultation and we can help you get back to patient care today.