Hospital revenue cycle management gaps can leave millions of dollars on the table every year. With community hospitals closing at alarming rates, sealing these gaps is critical to protecting the bottom line.

In the healthcare industry, challenges such as denied claims significantly impact revenue and staffing resources, highlighting the importance of healthcare organizations in effectively managing their revenue cycles to maintain a healthy cash flow.

Denied claims are a costly and time-consuming headache for hospitals, significantly adding to the administrative burden. The billing process, fraught with potential errors, can lead to claim denials, impacting the hospital's bottom line and increasing the hassle factors related to payer relationships. While the industry claims denial average ranges from 10-25 percent each year, turning around a high denial rate presents a major opportunity to boost the bottom line, reduce time in A/R, improve staff efficiency and productivity, and better the patient experience.

Because claims can be denied for a wide range of reasons, hospitals should analyze revenue cycle data to uncover the top causes for denials and create an action plan to address those issues. Errors in prior authorization, insurance eligibility, claims processing, and more can cause trouble. Addressing these errors can significantly reduce the administrative burden and improve the efficiency of the billing process.

While about two-thirds of denied claims can be recovered according to The Advisory Board, the time and effort it takes to secure reimbursement can be expensive and cumbersome. The Advisory Board also found that up to 90 percent of claim denials can be prevented.

Leverage your EHR system to prevent as many denials as possible by automating claims reviews to help ensure data is accurate and complete before submission, flagging outstanding claims for follow up, and providing opportunities to correct inaccurate or missing data throughout the claims process.

Strategy #2: Review and Monitor Payer Contracts

Another way to reduce the likelihood of denied claims and help ensure maximum reimbursement from payers is to regularly review contracts and track whether reimbursements match the expected amount.

Contract negotiations and management can be difficult to keep up with without tools that help automate code analysis and organization. When contracts are updated without a close look, hospitals risk forfeiting full reimbursements due to changing codes or vague contract language that payers use to their advantage.

In addition, the sheer volume of payments coming into the hospital makes it hard to catch underpayments in a timely manner. The longer a hospital waits to address these underpayments, the less likely it is to recoup.

For a small hospital A/R team, thorough contract management may seem like an insurmountable challenge, especially if this is being managed manually or through several different revenue cycle tools. A robust contract management tool that works seamlessly within the hospital’s EHR can streamline this process and provide oversight of contract maintenance, support underpayment tracking, and help recoup costs.

Strategy #3: Reduce Time in Accounts Receivable

The longer it takes for a hospital to go from care completion to reimbursement collection, the more risk there is for leaks to happen. To prevent money from slipping through the cracks, hospitals should take a hard look at how long claims spend in Accounts Receivable (AR) and identify and remedy delays as much as possible. These delays can lead to significant cash flow issues for healthcare organizations, as inefficiencies, high denial rates, and locked potential revenue directly impact the financial health of independent medical practices.

An effective revenue cycle solutions tool can reveal the sources of delay: provider lags in delivering documentation, A/R time to file claims, lengthy waits for payer reimbursement, missing data that results in communication loops, and more may be to blame. Finding the source of the issue and creating a plan to fix and prevent those problems moving forward can make an impact on the hospital’s cash flow and efficiency.

Healthcare Revenue Cycle Management Services

MEDTEAM can make an impact on your hospital’s bottom line and financial performance by streamlining and automating processes, relieving strain on staff, and extending your capabilities with our team of professionals.

By leveraging MEDTEAM's services, hospitals can significantly improve their operational and financial performance. Our approach ensures that medical services are efficiently managed, leading to enhanced patient satisfaction through accurate billing and streamlined healthcare delivery. An essential part of this process is informing patients about their financial responsibilities and required information before medical visits. This not only helps in managing revenue generated from the provision of medical services but also in automating duties like reminding patients of upcoming appointments and existing balances, thereby optimizing the overall revenue cycle management.

For more information, please contact your Customer Success Executive.