The financial stability and operational effectiveness of all hospitals and healthcare systems are negatively affected by the problematic issue of revenue leakage. The uncollected or delayed payments cause healthcare to lose tens of billions yearly.
This blog intends to raise awareness of the crucial revenue leakage problem in the healthcare sector. It strives to inform healthcare administrators and providers about the number of aspects of revenue loss, including coding errors, documentation problems, denied claims, and revenue cycle inefficiencies. Healthcare organizations, in return, can optimize their revenue loss, enhance financial stability, and deliver high-quality patient care through improved revenue cycle management procedures and minimized losses.
What is revenue leakage?
Revenue leakage within a healthcare institution can result in operational inefficiencies, hampered patient care, and decreased expenditures in infrastructure and technology if preventative steps are not taken.
According to a recent study done by Medical Group Management Association®, most insurers underpay providers by an average of 7% to 11%, meaning the majority of healthcare organizations do not receive full payment for their services. Based on this data, one can infer that it does get tougher to recover the money the longer you wait to follow up on the payments.
Causes of Revenue Leakage
- Coding Errors: Incorrect medical coding, either from a lack of specificity or incorrect assignment of codes, can lead to underbilling or overbilling, resulting in revenue leakage.
- Documentation Issues: Insufficient or missing documentation may result in under-coding, which results in improper billing for the services provided and a loss of revenue.
- Denied or Delayed Claims: Errors in submission or inadequate information can lead to claims being denied or delayed for the healthcare provider.
- Billing and Collection Inefficiencies: When overdue sums are not rightfully worked upon, it may cause payments to be delayed or revenue opportunities to be lost.
- Lack of Payer Contract Management: Not effectively managing payer contracts and fee schedules can result in underpayment for services rendered, leading to revenue leakage.
- Inaccurate Eligibility Verification: Before providing treatments, it is important to confirm the patient’s insurance eligibility and coverage to prevent giving uncompensated care to patients who are not covered.
- Credentialing Services: This issue can cause revenue leakage in a healthcare organization by leading to delayed or denied payments from insurance providers. If providers are not properly enrolled or credentialed, claims may be rejected, resulting in financial losses for the organization.
- Prior authorization: If prior authorizations are not obtained or are not processed in a timely manner, patients may receive services without adequate coverage, leading to potential non-payment or reimbursement issues for the healthcare provider.
How to Prevent Revenue Leakage?
Revenue leakage in a healthcare practice can be prevented through the following aspects:
- Accurate Coding and Billing: Implement robust coding practices to ensure accurate and compliant coding of medical services.
- Comprehensive Documentation: Ensure complete and accurate documentation of all medical services provided. Use Electronic Health Records (EHRs), Practice Management Systems (like expEDIum Medical Billing®), and other documentation systems to capture all billable services, reducing the risk of revenue loss due to incomplete records.
- Claim Scrubbing and Denial Management: Implement an efficient denial management process to quickly identify and resolve denied claims for maximum revenue recovery.
- Payer Contract Management: Regularly review contracts and negotiate rates to avoid underpayment and optimize revenue collection.
- Strong identity and access management: To resolve credentialing issues, maintain up-to-date provider credentials, centralize the enrolment process, and use automation tools. Also, outsourcing to a reputable credentialing provider might be a prudent choice.
- Pre-authorization management: Efficient pre-authorization workflows, real-time verification, and staff training can prevent revenue leakage in clinics and hospitals.
At iTech workshop, the main goal of our RCM team is to prevent revenue leakage. The platform streamlines billing procedures, makes payer contracts easier to administer, and provides insights for better financial performance monitoring. Our RCM team can help reduce errors, guarantee prompt reimbursements, and maximize income generation with smooth integration and compliance conformance. Through our expEDIum Suite of Products and RCM services, we can prevent revenue leakage and optimize our clients’ financial performance. Contact us for further information on how we can assist you.