As we continue to wrestle with the changes in healthcare during the pandemic, examining your revenue cycle management (RCM) is critical, as making the most of collections is crucial when productivity is harder to sustain.

Laurie Morgan, practice management consultant with Capko & Morgan, shares that too often, the teamwork required is overlooked because administrative tasks are siloed. The interplay between the scheduling, eligibility checks, collections, and billing functions should be integrated, as all are related to the revenue cycle. Providers also play a key role with documentation and coding.

“Improving collections really is a team effort, and the more you work together as a team, the better your collections are going to be,” said Morgan. “Communication and interaction between the front desk staff and the billing team are so important. It is worth the time to retrain, if needed, especially if volumes are lower, to make sure everyone understands why collecting specific types of information at certain times is so valuable.”

The most profitable strategy, Morgan explains, is for practices to “get things right the first time.” Relying on the billing team to fix mistakes adds to the time it takes for a claim to be submitted, increases the risk that the claim won’t be processed properly, and adds costs—including a higher likelihood of not being paid. Morgan recommends keeping the clean claims rate at 98% or 99% with a denial rate under 5%.

Managing details is essential to driving profitability, and Morgan highlights common billing mistakes. Oversights that can cost your practice money include:

• Patients arriving without verified coverage beforehand (unless paying in cash)
• Denials for insurance or demographic information not being captured correctly
• Denials due to not filing a claim on time

“Every mistake that happens affects your future profitability and the ability to get paid quickly,” said Morgan. “The Medical Group Management Association estimates there is a cost of $25 every time a claim needs to be reworked. If you have repeat errors, you have more delayed and denied claims, which directly affects your bottom line.”

If you outsource your billing, Morgan says it is important to have an integrated system that allows patient data to flow through to the billing system to ensure claims are processed in an automated and frictionless manner.

“Work with an RCM service that makes it fast and easy to submit claims so that you get paid quickly,” said Morgan. “The integration with your scheduling helps ensure the system can let you know when visits haven’t been billed.”

For more information on examining your billing practices and improving collections, as well as other ways you can position your practice for profitability and sustainability as businesses re-open, view Laurie Morgan’s full webinar: 5 ways to help your practice thrive during the pandemic.

Disclaimer: The views expressed by Laurie Morgan in this blog post do not necessarily reflect the views of Quest Diagnostics®, or any of its employees.