Top 7 Factors Affecting Your Practice’s Revenue

Did you know? The Medical Group Management Association (MGMA) reported that the healthcare practice's could save $16.3 billion or 42% of the $39 billion on administrative transactions with proper revenue cycle management.

If you observe that other healthcare providers are performing better than you while providing the same healthcare services, then something is definitely wrong in terms of your medical billing and coding. The only thing you want in such a situation is to dismiss the happenings like this, mainly when your practice has started picking up the patients count and increasing the profits after the pandemic.

To understand how to mitigate the revenue loss incurred by your practice, you need to know the factors that lead to financial damage. This article will look into seven top factors that affect your practice’s revenue once you have identified that you can pay attention to and improve your revenue cycle management.

Factor 1: Interpreting the Billing Rules

Undoubtedly, there are proper billing rules in the medical industry but different rules allow different interpretations of it. It can sometimes be the reason for the difference in revenues among practices that offers the same service. The best way to go about it is to find an outsourcing partner with knowledge about billing and the right way to follow the RAMQ standards.

A professional should know how to interpret the rules accurately, so as to avoid the underbilling or overbilling. Both the situations can be problematic as any underbilling would result in revenue loss where as overbilling will draw the RMAQ inquiry for your practice.

Factor 2: Failure to Credentialing & Enrollment

There are only few practices that often ignore updating the credentials and the enrolment of the new providers on time. But it has a huge impact as the failure to do so results in delayed payments, claim denials, out-of-network services, and eventually loss of revenue for such practice's. Therefore, it is vital that updating the credentials and enrollment at regular intervals should be part of the revenue management system of any practice.

Factor 3: Mitigating Denials

Even though the most common issue faced by a medical practice is the claim denials. But it doesn’t mean that you should give up on following them up. There are several reasons that can result in claim denials such as coding errors, lack of information in the billing, duplicate claims, failure to file the claim on time, eligibility, to name a few.

You must monitor the claims made as they can be denied. Following up on each claim and understanding why it has been rejected is the key step in managing the claim denial issue. Train your staff to recognize the problems that cause the denial and prevent the mistakes from happening in the future.

Factor 4: Understanding Your Agreement

In a medical practice, each disciple has their own agreement and set of rules. With these customized particulars in place for the practice, you must understand the agreement and its details. This factor also includes the amendments made and new rules and regulations that need to be implemented in the contract. Failure to follow such rules set in the agreement, your practice would result in revenue loss and increased liability in terms of heavy fines.

Factor 5: Selecting the Right Software

Undoubtedly, there are many medical billing software in the market, but finding the right one is your job. Software that helps with billing optimization is a must. For instance, the software can notify when data is missing from the billing and update or change the codes. In addition, using intelligent and updated software helps in preventing revenue losses. Any practice that fails to do so is putting them at a disadvantage since they cannot capture the benefits of the revenue system.

Factor 6: Verifying Patient Eligibility

When you need to get paid by the insurer and manage the revenue system, verifying the patient’s edibility is necessary. Many patients nowadays are required to make the payment during service, especially when they are in cost-sharing and high-deductible insurance plans. It’s through the eligibility verification only that you can verify these details well in advance and notify the patient about the cost before they actually takes the service. This process thus helps in recovering the cost of the service rendered and mitigating the claim denials.

Factor 7: Tracking the Financial Performance

For having a successful practice, regular tracking and monitoring of financial performance are essential. To do that, you must regularly analyze the KPIs and keep a keen eye on the areas causing revenue leaks. This process will help you enjoy a consistent cash flow for your practice. Also, the best way to get a track of such areas is to go in for customized reporting as prepared by the outsourcing medical billing and coding partners.

Additional Tip!

Undoubtedly, all these seven factors can help you mitigate the impact that can affect your practice’s revenue. But one of the best ways to move ahead is to outsource your medical billing and coding services to a knowledgeable third party who can take care of it all while you can concentrate on providing the best service to your patients. 24/7 Medical Billing Services can be one such outsourcing partner for all your medical billing and coding needs with a team of professionals.

Read more: Top Six Ways To Increase Your Practice Collections In 2022