4 Revenue Cycle Process Inefficiencies

Is your hospital leaving money on the table when it comes to revenue cycle management? Some healthcare organizations struggle to identify the clear money-draining black holes; some are aware of them; however, they lack the time and tools to resolve the issues. We all should be shocked that a staggering fifteen cents of every US healthcare dollar is lost because of revenue cycle inefficiencies.

We all know that hospital margins were slim; before the COVID-19 pandemic, the median hospital margin was 3.5%, and the current outlook is not looking great.

Lori Intravichit, CEO of Sunlit Cove Healthcare, said:

For any hospital, a positive operating margin is essential for long-term survival. Having an efficient revenue cycle can ensure a positive revenue stream. When the revenue cycle is inefficient, it increases billing errors, lost revenue, and unnecessary administrative time and expense.

Here are the top 4 Revenue cycle process inefficiencies:

1. Patient Access

Why is it still difficult for your front office staff to collect upfront?

Research from Medical Economist points out that providers only have a 30% chance of collecting on a patient balance after the patient walks out the door. Make it convenient for patients to pay, make it easy for them to understand what they owe, and allow them to pay however they want. Accept credit and debit cards, payments over the phone, online, by check, or set up a monthly billing plan. Think beyond the office and think differently with digital admissions.

2. Unbilled Services

It is still surprising how often this happens with all the great technology we have. A simple daily query of appointments with no charge should solve the issue. However, it is not as black and white, and it often goes back to internal processes. The coding team thinks the ball is in the billing team’s corner, and the billing team is sure that it goes back to the front office registration. Time to start looking at your policies and procedures development and implementation.

3. Medical Code Errors

Undoubtedly, it is becoming more and more challenging to stay on top of the medical codes, especially with the ongoing Covid-19 pandemic. Your organization needs proper staff training to avoid: incomplete documentation, missing intake information, using incorrect codes for linked procedures, upcoding, undercoding, duplicate billing, and using the modifier 22-increased procedural services when appropriate.

4. Denial Management

According to the latest report, hospital claim denials are steadily rising and rising to 23%.

Three simple steps to Denial Management and Prevention:

  • Collaboration of the Case Management, Billing and Collections departments
  • Financial Analysis
  • Physician Education

For more information regarding the resources required to successfully prevent denials and find a root cause within your business office check out this link.

The Sunlit Cove Healthcare team can help your organization identify revenue cycle process inefficiencies and provide strategies to prevent them in the future.
Start today and schedule your free process review!

Sunlit Cove Healthcare Consultants provide revenue cycle staff management services on a continuous or as-needed basis for a reasonable rate. No need to hire staff as volumes shift with the constantly changing environment. We work on a flat fee basis that will allow your budget not to fluctuate. Contact us or give us a call at 727.576.2903!

Sunlit Cove Healthcare Consultants

We provide management and consulting services to help healthcare businesses run efficiently. Navigating the dynamic and complex revenue cycle management is a challenge for many health plans, health care vendors, and providers. Our consulting services are available to assist with your day-to-day operations and provide expertise in growth and change management. We manage all aspects of your enterprise from the development of the revenue cycle management process to the completion of your business cycle.

Revenue Cycle Interim Management: