Does Your In house Team Lack Deep Insights into the Revenue Cycle?

Irrespective of the size of the services they provide, many healthcare facilities have been grappling with failure to manage their revenues with the in-house team. It is quite possible that despite all the efforts that the in-house medical billing and coding team is putting into managing the revenue cycle ends up with nothing. The failure is not because they are reluctant to do the job but due to the insights caused by the multiple changes and disruptions in the medical billing system.

Added to this, they face continuous obstacles when it comes to payment collection due to the changed behavior of the patients and the insurance providers. Often ignoring all these, the in-house team struggles with the revenue cycle management resulting in the practices to upend their business to stay afloat.

So if your in-house medical billing and coding team is also constantly fighting to keep the revenue cycle on track, miserably failing can be due to any one of multiple of the following reasons-

1.  Lack of training

Most of the medical billing and coding companies fail to provide constant training to their staff and upgrade their knowledge about the changes related to medical billing, coding, reimbursements, and insurance policies. In addition, as more experienced staff exits the practice, the necessity of training diminishes with the focus on how to work out the staff deficit along with working with the inexperienced staff.

The result is getting the wrong information. Also, the inefficiencies are starting to take a toll on the revenue and practice.

2. Not validating the information

The in-house medical billing and coding department is the first line of contact in getting the correct data. The staffs need to know the changes that can be made before submission. For each claim, they need to know the information to be put in to ensure it is acceptable to the payer.

In fact, any data or claim protocols that are not working need to be identified immediately by the in-house medical billing and coding department to ensure the claims are handled correctly and are not getting rejected. Further, they need to work constantly with the payers and other team members of the practice to check the data that is not working and might be overlooked by the management.

3. Failure to monitor data

The in-house team must be trained to identify and correct any billing errors before submitting them. When they fail to monitor these errors, the result is an increase in denials and a decrease in revenue. Hence, any training material you have for the in-house revenue management team needs to be updated constantly, which will reflect the changing protocols in the medical billing and coding system, the changes in the policies of the insurances, and a scrub. Including the scrub would also allow the team to monitor and make the correction and necessary modifications before the claim so it doesn't get denied.

Any lack of implementation protocols would mean a continuation of denials and damage to the revenue cycle.

4. Failure to work the denials

Despite doing all the good work, denial is something that will happen once in a while. It has been a constant battle for most of the facilities and often forces them back to go old school of tracking the confirmation, faxing the details, or finding a solution that can be done to receive the payment. But all these mean losses of labor, time, and delays in the payment, affecting the overall long-term revenue.

5.  Not understanding the payer contracts

Payer accountability is one of the critical areas that help manage the revenue cycle. The staff's job is to monitor and understand the contracts, do a regular audit, and ensure the payer is upheld. It would be a rare situation when a payer will contact you for the underpayment or notify renewal timeframe.

But with the right billing software in place, reports can be extracted to recognize any negative behavior by a payer. This data can be used to act upon to manage the revenue.

How to Get Out of the Cycle of Failure?

One of the best ways to ensure that your in-house medical billing and coding team is not dragging you down regarding revenue cycle management is by outsourcing the entire procedure to the experienced team of 24/7 Medical Billing Services.

24/7 Medical Billing Services is one such organization that manages the medical billing and coding of medical service providers and ensures the revenue collection is on time. In addition, intelligent insights are offered with a proper data collection system.

Also, there is very less scope for claim rejection due to the trained and dedicated staff to take care of the billing system with due follow-up for every claim. 24/7 Medical Billing Services as the medical billing partner will create a profitable revenue cycle management while the practice can focus on patients and the in-house team on other administrative works.

Read more: CMS Issues New Policies To Provide Greater Transparency For Medicare Advantage And Part D Plans