They can include the following:
- Inaccurate coding and billing - If medical codes are incorrect or incomplete, it can lead to denied claims and loss of revenue. Having properly trained coders is essential.
- Long collection times - Slow or inefficient collection of patient payments from insurance companies and patients themselves can tie up funds and hurt cash flow. Average collection times should be closely monitored.
- High denial rates - Denials from insurance companies for various reasons like improper coding, incomplete documentation, lack of pre-authorizations, etc. Denials must be quickly addressed and appealed if necessary.
- Patient registration errors - Inaccurate patient information entered at registration can cause claims to be rejected or sent to the wrong payer. Data entry should be validated.
- Poor charge capture - Failure to record all billable items and services provided during patient care leads to lost revenue. Audits help ensure full charging.
- Lack of pricing transparency - Patients may be unclear on what they will end up owing, especially if they are uninsured or policies have high deductibles/copays. Financial counselors can help provide estimates.
- Failure to verify insurance eligibility - Not checking a patient's active coverage status can mean more claims get denied. Eligibility should be confirmed prior to non-emergency services.
- High accounts receivable days - Letting accounts receivable stretch over 60-90 days can negatively impact cash flow. Close monitoring and follow-up on unpaid claims is essential.
The key is having a well-designed audit system that analyzes every remittance received in a 12-to-24-month period to determine contractual compliance of each reimbursement.
These case studies demostrate the difference it can make to the bottomline.
Setup a call with the president/owner of our company to review your situation.
Larry Potter
Senior Advisor
Lgpotter33@gmail.com
Text: 1-847-872-4047
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