5 barriers to a healthy revenue cycle
When we look at the general healthcare industry, it’s obvious that there is plenty of room for improvement when it comes to revenue cycle management. For many practices, healthcare revenue cycle staff frequently play catch up, spend a ton of time fighting denials, or cannot evaluate basic performance metrics, indicating that there’s a bigger problem lurking beneath the surface. While there are many reasons why medical practices experience business revenue cycle challenges, here are five of the most common barriers to success.
Manual RCM processes
If your medical practice depends on manual claims processing and follow-up, you’re likely spinning your wheels trying to maintain a healthy revenue cycle. Manual revenue cycle management processes, combined with an outdated information technology system, is a recipe for long-term revenue cycle challenges. Not only will you experience a drain in RCM staff productivity and efficiency, you’ll also find it nearly impossible to detect errors and other mistakes that delay reimbursement.
Leveraging electronic processes helps you prevent errors prior to claim submission, analyze payment trends and reasons for denials, identify and resolve billing and compliance errors, expediate payer claims processing, and so much more.
Limited access to top RCM talent
Given today’s ongoing healthcare staffing shortages, you may find yourself compromising your operational needs simply to fill vacant revenue cycle management positions. However, this can backfire if a medical coder or medical biller doesn’t have the right experience and knowledge to ensure compliance and revenue integrity. Partnering with a reputable outsourced RCM vendor can help keep your revenue cycle on track and prevent long term revenue cycle challenges. So can remote work arrangements that allow to you to expand your candidate search.
It is also important to evaluate whether you have the right leaders in place to promote a healthy revenue cycle. While it’s challenging to recruit and retain medical coders and medical billers, it can be equally as difficult to find the right medical practice manager. This individual plays a critical role in terms of setting the overall tone of the workplace and helping maintain momentum in your healthcare revenue cycle, so finding the right fit is critical.
Lack of staff training
Even knowledgeable and experienced medical coders and medical billers require ongoing education. In fact, complacency is the enemy of a healthy revenue cycle. If you don’t create a budget for continuing education, your medical practice will ultimately pay the price through increased denials, outstanding accounts receivable, and other long term revenue cycle challenges.
Be sure to check out the Academy of Professional Coders (AAPC) website for more information about continuing education offerings as well as educational requirements by credential.
Revenue cycle management apprehension
This is a tricky one because it can be difficult to address—especially when there are deeply-rooted ways of handling business revenue cycle challenges. For example, perhaps your medical practice has always ‘played it safe’ when it comes to evaluation and management (E/M) coding, so you never bill anything higher than a level 3 E/M code. The problem with this is that there are probably many instances where a level 4 or 5 is warranted, which means you’re losing out on revenue.
Or perhaps your medical practice has always used the same EHR because that’s the technology with which everyone is familiar. But what if there’s no patient portal or it isn’t designed for your medical specialty? You could be missing out on opportunities to improve patient care, gain efficiency, and generate more revenue.
Now is the time to speak up and have conversations about what the future (and a healthy revenue cycle) could look like, and how everyone will benefit even if change is scary initially.
Inconsistent front-end RCM processes
Every healthy revenue cycle requires a strong foundation, and in healthcare, this means consistent and comprehensive processes for provider credentialing and patient registration. Errors and/or omissions in one or both processes have a negative domino effect on the rest of the business revenue cycle. To ensure accurate reimbursement, your medical practice must focus on data integrity, ensure timely updates, and continually look for ways to improve revenue cycle management workflows.
The RCM partner you need
If your medical practice struggles with one or more of these barriers to a healthy revenue cycle, now is the time to start thinking about how you can overcome them. It’s never too late to get things back on track and establish a strong financial foundation for your medical practice. Learn how edgeMED can help improve your healthcare revenue cycle.
