Your medical organization is only as successful as its revenue cycle management, so it is imperative to ensure you are tackling the common issues that come along with your particular management software. Many of these obstacles stem from communication disturbances, but it is imperative to solve them to ensure a steady stream of revenue for your organization.
1. Poor Accounts Receivable Practices
If you are not staying on top of your a/r practices and maintaining consistency when it comes to billing, you are subjecting your organization to a potential loss of revenue. Collections and follow-ups need to be done in a timely manner to ensure that the money owed to your organization is being collected and coordinated with the insurance companies.
2. Properly Managing Prior Authorization
Insurance eligibility can be unpredictable at times. To avoid denials, it is often suggested to use prior authorization which can alleviate some of the difficulties that come with dealing with insurance companies. This allows providers to obtain the necessary permission from insurance companies before providing care to the patient.
However, if this is not properly managed, more issues can arise. Prior authorization is a time-consuming task so when mistakes are made in the process, this can cause more inconvenience and delays for your organization and the patient.
3. Recording Revenue Accurately
In your healthcare organization, revenue integrity is integral to your RCM. Your medical billing team must ensure that the correct dollar amount is being reported or providers may not be properly reimbursed. Without proper charge entries, the entire RCM can be inaccurate.
This can be especially hazardous for specialty care providers as their charges are not always as straightforward as primary care providers because conditions can be more complex and require face-to-face visits. These providers also tend to use multiple systems to collect information which involves other providers, complicating the process.
4. Following Proper Medical Coding Practices
One of the biggest challenges faced in the RCM is proper medical coding. Different specialty treatments and therapies are constantly changing in terms of coding. If these are not properly recorded in your RCM, your company is at a disadvantage and can ultimately lose revenue. Because this may be a lot for an organization to keep up with and maintain accuracy, many groups choose to outsource their medical coding teams.
5. Drug and Treatment Pricing and Payer Contracts
As care becomes more complex, prices of services and prescriptions are often raised. Because these treatments are so innovative, they are becoming more popular, which can mean great things for your organization. However, it is imperative that your team is aware of the most up-to-date prices on these drugs to be reimbursed fully.
By utilizing the right experts, you can be sure that your company is always up to date and ready to take on the most complex of medical billing cases.
Trust Us With Your RCM
At Credence Global Solutions, our team of experts is equipped with the knowledge and tools to tackle the most complex RCM cases. By staying up-to-date on all policies, procedures, and prices, you can be assured that your company will get the most out of its revenue stream.
To learn more about how we can help your organization, contact us today!