6 ways to meet revenue cycle management goals in your medical practice
Your medical practice’s monthly revenue is probably relatively consistent. But what if you start to notice a pattern of not meeting revenue cycle management goals? Would you know what to do and how to increase medical revenue? Assuming everything will eventually ‘work itself out’ isn’t necessarily the right answer. And if you don’t address problems in a timely manner, a lack of funds could cause cashflow problems and other operational challenges. Here are six strategies that can help get your revenue back on track.
Address the root cause(s) of claim denials to meet revenue cycle management goals.
Unexpected dips in medical practice revenue could be due to payers simply not paying your claims. That’s when you need to drill down into the root cause of any claim denials and implement safeguards (e.g., claim edits) to ensure compliance. For example, pervasive claim denials could occur if one of the ICD-10-CM diagnosis codes you typically report suddenly becomes invalid on October 1 with the annual medical coding update—and you continue to report it. (Note: Here’s a link to the fiscal year 2025 ICD-10-CM medical coding updates.) Or they occur if a medical coder unknowingly transposes two numbers in a CPT code, inadvertently submitting a noncovered service with every medical claim submission.
Something else to keep in mind about revenue cycle management for healthcare: If you use batch healthcare claim submission, medical claim errors could go undetected for longer periods of time. It may be time to rethink your revenue cycle management for healthcare strategy and consider real-time claim submission instead—especially if you’re thinking about how to increase cashflow.
Be mindful of downcoding when exploring how to increase medical revenue.
Sometimes dips in medical practice revenue aren’t due to claim denials but rather a payer’s downcoding your services (i.e., reducing the level of service on a claim to a lower-complexity CPT code). When this starts to happen consistently over time, you may begin to see a decrease in revenue at which point you’ll need to review medical record documentation to ensure you’ve met all components of the coded service. When thinking about how to increase medical revenue, you may want to consider submitting an appeal letter supporting a higher service level, when appropriate.
Examine patient volumes in your medical practice.
Sometimes you can attribute an inability to meet revenue cycle management goals to decreases in patient volume. One easy explanation for this? A provider was on vacation for two weeks, and then their physician assistant was out for another two weeks. However, another reason could be that the patient experience has started to suffer due to unaddressed provider burnout, healthcare staffing shortages, or a variety of other reasons—and you’ve gradually lost patients to a competitor. If this is the reason for not meeting revenue cycle management goals, it’s time to refocus on patient engagement. Where do disconnects occur, and what can you and your staff do to improve the overall experience and enhance patient retention?
Consider technological glitches that could impact revenue cycle management for healthcare.
If you start to notice a decrease in medical practice revenue, one reason could simply be a technology problem at your end, at the clearinghouse, or at the point of payer processing. These medical claim processing problems could happen at any time, including times of transition when switching to a new electronic health record. As you explore how to increase medical revenue and how to increase cashflow, be sure to engage your payers for smooth claims processing.
Monitor payment variances in your medical practice.
Have you recently renegotiated a payer contract? If so, contractual misunderstandings could suddenly lead to underpayments that fuel an inability to meet revenue cycle management goals. Verify your contracts and fee schedule, and cross check this information with payment rates. When discrepancies occur, appeal those claims and enclose a copy of the fee schedule.
Don’t forget patient payments when thinking about how to increase cashflow.
These days, more of your medical practice revenue probably stems from patient payments than ever before. However, if you don’t have a solid process for up-front and back-end collections, your revenue will suffer.
Looking ahead: Revenue cycle management for healthcare
Meeting revenue cycle management goals consistently requires proactive planning, diligent monitoring, and a commitment to ongoing process improvement. However, with the right people, processes, and technology, it’s possible—and even easier than you might think. Learn how edgeMED can help.
