Advanced Revenue Cycle Analytics: An Overview

It’s important for your practice to stay on top of managing your revenue cycle. Like any business, your medical practice needs cash flow to stay afloat. Here is a list of 10 revenue cycle management mistakes you need to avoid to keep your practice running efficiently.

1. Falling behind on payer rules

With so many insurance providers out there, the complex and changing rules of each one are difficult to keep up with. When submitting claims, it is easy to forget the specific rules of that payer, which leads to denied claims. Using a software like White Plume’s AccelaSMART can allow you to build custom rules for each payer, insuring you don’t miss a single one.

2. Failure to comply with ICD-10 updates

Every year the ICD-10 codes are updated. Codes are deleted or changed, and practices are expected to comply to those changes immediately. Not doing so will also lead to denied claims and a leaking revenue cycle. This is another area where a software like AccelaSMART can help. The ICD-10 codes are automatically updated every year so that your practice doesn’t have to worry about forgetting new or updated codes.

3. Submitting duplicated claims

A duplicate claim is any claim that is submitted by a physician or provider for the same service provided to an individual on a specified date of service that was already included in a previously submitted claim. This is one of the most common causes of denied claims, so making this mistake damages your revenue cycle.

4. Capture missed charges

Along with duplicate claims, missing charges entirely because they weren’t passed correctly from the EHR is another cause of denied claims. AccelaCAPTURE can ensure that your practice always passes charges correctly from the EHR to your PM system.

5. Forgetting to resubmit rejected claims

Claims that are rejected need to be resubmitted as soon as possible in order to gain that revenue back for your services. However, many practices forget or put off resubmitting claims. This is a huge pitfall to managing your revenue cycle well. When you don’t resubmit claims, you are leaving cash on the table.

6. Not verifying patient eligibility

Verifying patient eligibility is important before their appointment. If you wait till during or after, there is a greater risk of a denied claim, leading to a hefty medical bill falling on the shoulders of an unsuspecting patient who may or may not be able to make that payment.

7. Failure to collect at the time of service

It is important that practices are strict on this rule. Delayed payments will definitely hurt your revenue cycle. You may even have to hire people to track down and force patients to pay what they owe, which is wasted money that could be saved if point of service payment is the expectation every time.

8. Wasted time reviewing clean claims

Your coders spend a lot of time reviewing and processing claims, and the time they spend is money for your practice. Reviewing every single claim, even when they don’t have mistakes, is simply time-consuming. Your practice should have a software in place that allows exception-only coding, meaning your coders only have to review claims with mistakes. For example, AccelaSMART filters claims so that coders only review claims that have errors. This significantly increases coder productivity.

9. Using doctors as coders

Doctors spent years of their life training to practice medicine. They didn’t go to medical school to learn coding. Using them as your coders may lead to mistakes, claim denials, and possibly physician burnout.

10. Not having a backup plan for coder turnover

If you aren’t storing the information that your top-notch coders are using to submit your claims, what happens when one of them leaves your practice? There is a huge learning curve, and your revenue cycle takes a hit. You need to use technology that stores information and ensures consistency in your revenue cycle, no matter the turnover.

Looking for more tips to boost your revenue cycle? Download our free white paper, the Top 5 Secrets to a Successful Charge Entry Strategy.