Strategies for Minimizing Denials and Revenue Leakage in RCM


An efficient revenue cycle can promote the continuity of a healthcare organization by allowing it to meet its financial obligations. Seek professional revenue cycle management consulting if you’re experiencing revenue leakage to improve your chances of receiving proper and timely reimbursements. The right consultants can guide you on what to improve to reduce claim denials. Here are some strategies they may suggest:

Verify Proper Provider Credentialing 

Insurance companies require medical professionals to be credentialed before entering contracts with them. Credentialing is the process of verifying a medical professional’s education and training, certifications, and professional background. It can instill confidence in a professional as it proves competency in providing safe and high-quality care. Proper credentialing can promote timely service reimbursements. 

Cutting corners in credentialing may lead to reimbursement delays or denials. If you’re in a hurry to hire new providers, work with a credentialing company instead of cutting corners. Professional credentialing companies can expedite the process because of their relationships with key players like educational institutions and certification bodies. 

Confirm Patient Coverage 

Payers can only reimburse you for services offered to patients under their coverage. Ask for patients’ insurance information several days before their appointment to allow you to verify their benefits before treatment. A professional revenue cycle management consulting firm will likely tell you to verify patient coverage regularly, even if they’re frequent patients, as coverage can change because of factors like policy modifications.

Verifying coverage can let you know whether your patient’s insurer can pay for the services you want to render. If not, you can inform patients about their financial responsibilities before their appointment to prevent potential disputes and protect your revenue. 

Seek Prior Authorization When Necessary 

Refrain from assuming payers will reimburse you for all services offered just because you confirm patient coverage. Payers can deny claims for certain services if provided without seeking prior authorization. These services include major surgeries, like organ transplants, prescription of specialty drugs, and chemotherapy treatments. Review the guidelines your patients’ insurers provide to identify procedures requiring prior authorization. Send authorization requests a few weeks before your patients’ appointments to give their insurers sufficient time to approve treatment. 

Review Medical Billing Codes 

Medical billing codes are beneficial in healthcare as they allow providers to communicate with insurance companies by converting patient records into a language the latter can understand. They also improve consistency in billing as all providers use them to claim reimbursement.

Take the time to understand these codes, as billing the wrong ones can result in payment denials, underpayments, or overpayments. These can affect your revenue cycle and, in some cases, result in fraud charges from insurers. Work with professional medical coders to protect your healthcare organization. Professionals can keep track of medical coding changes on your behalf, allowing you to focus on providing healthcare services. 

Enter Correct Claiming Details 

Entering incorrect patient identifiers can cause delays or denials, as insurers are often strict when reviewing claims. You can reduce rejections by crosschecking patients’ details during registration. Make sure you get their correct names, birth dates, locations, and subscriber information.

Consider integrating your electronic health record (EHR) system with your medical billing software. This can facilitate automated data transfer from your EHR to your billing software. Minimizing manual data entry can reduce the risk of making errors like keying in incorrect patient demographics. The more accurate and efficient your billing is, the higher your chances of receiving timely reimbursements. 

Invest in Revenue Cycle Management Consulting 

Optimizing your revenue cycle management can improve your financial performance by lowering the rate of claim denials. It can also reduce billing disputes with patients by enhancing transparency in the billing process. Hire a revenue cycle management consulting company to help identify inefficiencies in your current billing process if you’re experiencing numerous revenue leakages. They can develop customized solutions to improve your revenue cycle. 

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