Common RCM Pitfalls to Avoid

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Common RCM Pitfalls to Avoid

• A practice that’s unable to reduce revenue leaks and increase their bottom line will have a hard time staying afloat.

• When it comes to minimizing costs and managing revenue, medical practices of all sizes make the same mistakes. Here are 7 common RCM pitfalls to avoid at all costs.

Not Collecting at Point of Service

• Not everyone is comfortable collecting from patients at point of service (POS), but avoiding this task can put your practice’s revenue at risk.

• Should a payment not occur at POS, a lot of time and money is spent following up and chasing after patients. There are the endless phone calls and emails and paper invoices, and all of those “minor” expenses add up, not to mention the expense of having to hire a collections agency.

• Multiply these expenses by “X” number of patients and your revenue soon develops a slow and steady leak.

• The moral of this RCM scenario is, it’s much harder to get patients to pay once they’ve been treated and are out the door, so make sure your staff has been trained on these procedures and can clearly communicate your collection policies.

Not Submitting Daily Claims

• The claims submission process is time-consuming which is why many practices put off submitting their claims until the end of the week.

• Keep in mind that for every submission you delay there is a delay in being able to correct and resubmit claims that were denied. All of these delays add up to a backed-up revenue cycle. As unhealthy as it is for your patients to be “backed up,” it’s equally unhealthy for your practice’s financial health.

• To become even more efficient and profitable, make it a goal to submit claims at the end of each day. If you automate this submission process as much as possible with computer software, you can reduce the time and effort required.

Not Optimizing Time and Workflow

• Mismanagement of time (as well as staff workflow) in your practice leads to fewer patients being seen which ultimately reduces your revenue.

• In order to combat this lost revenue you’ll need to ensure accurate scheduling and that your staff is clear on their individual responsibilities.

• Also, it is always best to adopt a Murphy’s Law approach into your workflow, meaning, always make provisions for the unexpected to occur (a patient misses their appointment) so valuable time doesn’t get wasted.

Not Keeping Up With Payers’ Protocols and Policies

• Not staying current with payer policies can really wreak havoc on your revenue.

• For instance, let’s say a payer changes their identification number but you didn’t know it and submitted your claim with the old number, you won’t just be able to resubmit your claim with the right number. Your system must first be updated to support this modification, which of course means further delays in payment and a sluggish cash flow.

• You may be thinking, “How am I supposed to find the time to stay on top of all of my payers?”

• A great solution to this challenge is to partner up with a revenue cycle management vendor. It is their very business to always understand and maintain current policies, simplifying your claims filing processes and your life.

Not Resubmitting Denied Claims

• When claims get denied, some providers are reluctant to resubmit to certain payers because they don’t have the right tools that allow them access to the data they need to support the challenge. What happens then? Revenue is lost.

• A simple solution is to use comprehensive online research tools that always stay up-to-date with the latest information. The really good tools will not only point to exactly where the denial occurred but also automate the process of filing appeal letters and corrected claims.

Not Verifying Patient Eligibility

• A study by Emdeon (formerly Capario), found that 25% of providers never verify patient eligibility or copay amounts.

• In our estimation, that’s as essential as checking a patient’s vitals. It gets worse: the study also found that another 25% don’t get around to checking this information until AFTER the patient has left the building.

• This is a huge pitfall to avoid, especially since copays are increasing as are patient visits. Make sure your staff inquires about eligibility and copay amounts at each and every check-in.

Not Looking for Trends

• It’s important to make time each week to review claims and monitor for any high-level macro trends that could point to repeated processing errors.

• Look for a routine denial of claims for certain procedures or code. Finding and fixing these will improve both your short-term and long-term revenue cycle. You have a lot of data at your fingertips so mind it to understand the common mistakes your office is making, then adjust accordingly.

How can we help ?

• This simplest way to tackle these pitfalls is to partner with an experienced RCM team.

• CureMD helps providers face the complexities of their practice’s financial life by offering end-to-end RCM solutions, as well as denial management and resolution. Talk to us today and see if we can help you avoid these common pitfalls and keep your revenue cycle healthy.

CureMD Healthcare120 Broad Street, New York, NY

10271 Ph: 212.509.6200www.curemd.com

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