Common RCM Pitfalls to Avoid

1
Common RCM Pitfalls to Avoid
CureMD Healthcare
2
Common RCM Pitfalls to Avoid

• A practice thats unable to reduce revenue leaks
  and increase their bottom line will have a hard
  time staying afloat.
• When it comes to minimizing costs and managing
  revenue, medical practices of all sizes make the
  same mistakes. Here are 7 common RCM pitfalls to
  avoid at all costs.

3
Not Collecting at Point of Service

• Not everyone is comfortable collecting from
  patients at point of service (POS), but avoiding
  this task can put your practices revenue at
  risk.
• Should a payment not occur at POS, a lot of time
  and money is spent following up and chasing after
  patients. There are the endless phone calls and
  emails and paper invoices, and all of those
  minor expenses add up, not to mention the
  expense of having to hire a collections agency.
• Multiply these expenses by X number of patients
  and your revenue soon develops a slow and steady
  leak.

4

• The moral of this RCM scenario is, its much
  harder to get patients to pay once theyve been
  treated and are out the door, so make sure your
  staff has been trained on these procedures and
  can clearly communicate your collection policies.
  

5
Not Submitting Daily Claims

• The claims submission process is time-consuming
  which is why many practices put off submitting
  their claims until the end of the week.
• Keep in mind that for every submission you delay
  there is a delay in being able to correct and
  resubmit claims that were denied. All of these
  delays add up to a backed-up revenue cycle. As
  unhealthy as it is for your patients to be
  backed up, its equally unhealthy for your
  practices financial health.

6

• To become even more efficient and profitable,
  make it a goal to submit claims at the end of
  each day. If you automate this submission process
  as much as possible with computer software, you
  can reduce the time and effort required.

7
Not Optimizing Time and Workflow

• Mismanagement of time (as well as staff workflow)
  in your practice leads to fewer patients being
  seen which ultimately reduces your revenue.
• In order to combat this lost revenue youll need
  to ensure accurate scheduling and that your staff
  is clear on their individual responsibilities.
• Also, it is always best to adopt a Murphys Law
  approach into your workflow, meaning, always make
  provisions for the unexpected to occur (a patient
  misses their appointment) so valuable time
  doesnt get wasted.

8
Not Keeping Up With Payers Protocols and Policies

• Not staying current with payer policies can
  really wreak havoc on your revenue.
• For instance, lets say a payer changes their
  identification number but you didnt know it and
  submitted your claim with the old number, you
  wont just be able to resubmit your claim with
  the right number. Your system must first be
  updated to support this modification, which of
  course means further delays in payment and a
  sluggish cash flow.

9

• You may be thinking, How am I supposed to find
  the time to stay on top of all of my payers?
• A great solution to this challenge is to partner
  up with a revenue cycle management vendor. It is
  their very business to always understand and
  maintain current policies, simplifying your
  claims filing processes and your life.

10
Not Resubmitting Denied Claims

• When claims get denied, some providers are
  reluctant to resubmit to certain payers because
  they dont have the right tools that allow them
  access to the data they need to support the
  challenge. What happens then? Revenue is lost.
• A simple solution is to use comprehensive online
  research tools that always stay up-to-date with
  the latest information. The really good tools
  will not only point to exactly where the denial
  occurred but also automate the process of filing
  appeal letters and corrected claims.

11
Not Verifying Patient Eligibility

• A study by Emdeon (formerly Capario), found that
  25 of providers never verify patient eligibility
  or copay amounts.
• In our estimation, thats as essential as
  checking a patients vitals. It gets worse the
  study also found that another 25 dont get
  around to checking this information until AFTER
  the patient has left the building.
• This is a huge pitfall to avoid, especially since
  copays are increasing as are patient visits. Make
  sure your staff inquires about eligibility and
  copay amounts at each and every check-in.

12
Not Looking for Trends

• Its important to make time each week to review
  claims and monitor for any high-level macro
  trends that could point to repeated processing
  errors.
• Look for a routine denial of claims for certain
  procedures or code. Finding and fixing these will
  improve both your short-term and long-term
  revenue cycle. You have a lot of data at your
  fingertips so mind it to understand the common
  mistakes your office is making, then adjust
  accordingly.

13
How can we help ?

• This simplest way to tackle these pitfalls is to
  partner with an experienced RCM team.
• CureMD helps providers face the complexities of
  their practices financial life by offering
  end-to-end RCM solutions, as well as denial
  management and resolution. Talk to us today and
  see if we can help you avoid these common
  pitfalls and keep your revenue cycle healthy.

14
Thank you!
CureMD Healthcare 120 Broad Street, New York, NY
10271 Ph 212.509.6200 www.curemd.com