Usually, in primary care and other types of practices that are more office-oriented, payments from patients and insurers need to be made sooner rather than later if you want operations to go smoothly. If providers don’t manage the revenue cycle properly, you’ll start to see finances be impacted. While a mistake with one claim might seem small, you have to consider the many visits you get in a week. As claim errors rise, your finances continue to take a hit. Here are a few ways providers may make mistakes in their revenue cycle.
They Don’t Stay Up-to-Date With Payer Requirements
You can’t just go through your insurer’s newsletter and call it a day. There’s an abundance of instances in which it doesn’t suffice to simply resubmit your claim. Instead, you have to update your system so you can support the modification of the payer.
In short, if you don’t update your payer requirements, your cash flow will slow down, and you’ll have more claim rejects. It can help to work with a third-party medical billing company if you want to make sure your payer requirements are always current.
Not Monitoring the Whole Claims Process
It’s easy to say that something is wrong with the claims process. What isn’t always as easy is figuring out what part of the claims process needs adjusting. If you don’t monitor the whole claims process, you won’t know where things went wrong. This makes it difficult to put an effective solution together.
If you find yourself wondering what went wrong in your claims process, consider putting a business process together that includes thorough follow-ups. Find out what kinds of tools you can use to create proactive alerts to any problems your claims process is facing. Being proactive and finding problems as soon as they happen is much better than having to spend hours researching potential reasons for these problems.
Not Taking Note of Trends
Practices that have large administrative workloads usually process one claim at a time. Addressing claims one at a time can be an issue for administrators, though, because it becomes tougher for them to see certain macro trends, which could cause them to make certain process mistakes multiple times.
It helps to have workflow tools in place that will make a note of any recurring trends for denials. This will make both your long-term and short-term revenue cycle better. Understanding mistakes is the first step towards correcting them and submitting more claims.
You should also look into vendors who have proactive tools for reporting and auditing, modern coding information, and payer relationships. Doing this gives your team all of the necessary resources for streamlining daily revenue management, and it makes your practice performance much better.
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