The one thing the first eight months of 2017 has taught healthcare industry is that change is the only constant. In an ever evolving business environment, medical professionals, big or small, are struggling to keep up with increasing financial responsibility of their patients, especially with regards to Revenue Cycle Management (RCM) and the need to stay within the regulatory framework. As a result, it has pressured many healthcare organizations to rethink their existing operations.

In 2017, healthcare industry is gearing up to recognize any missed opportunities to reduce costs and streamline their processes to maximize profits. If research is any indication, as much as 30% potential revenue is lost each year due to RCM glitches. However, these issues are completely avoidable by adopting following practices that can optimize RCM.

Tighter Clinical Documentation Process

Complete and accurate documentation is the key to avoid loss of revenue due to denied claims. You can consider implementing technology that will prompt the user to add all the required details into the system before an entry is saved. Through precise documentation, the organization can ensure that it will receive claim payments and also reduce the cost of following up on rejected claims.

Data Mining to Analyze Potential Roadblocks

The best way to avoid problems later is by detecting its source early on and working on its improvement. Use an analyst to mine the data and analyze it to identify possible roadblocks in smooth claim conclusion process. Sometimes examining your backend systems will reveal the true reason that is affecting your revenue cycle. Finding this reason can be the first constructive step towards RCM optimization.

Review Payer Contracts

In order to eliminate the losses incurred due to claim denials and underpayments, you must thoroughly review the payer contracts from time to time. Failure to receive claims payment can put your healthcare business in financial turmoil faster than you can handle. To avoid such situations, you should consider looking into missing payments. You can also consider involving an expert who can review your revenue cycle periodically. This way you can focus on providing quality care to your patients, without worrying too much about your payments and finances.

Employ Business Intelligence Tools

Custom business tools are designed to recognize organizational strengths and opportunities. Things like root cause analysis and performance dashboard can help healthcare businesses to see their improvement areas that will help them enhance their performance and reduce claim denials caused to oversight or lack of efficiency. At the same time, reviewing performance from time to time can help you identify best practices that can be further strengthened to increase revenues.

It is common for medical practices to lose revenue due to improper billing. However, the good news is that you can unburden yourself of revenue cycle inefficiencies by using professional healthcare support services providers like us. We provide the most comprehensive portfolio of revenue cycle management services to hospitals and other healthcare practices globally. If you need a reliable outsourcing partner for your RCM needs, talk to us today.


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