With inflation raising costs from staffing and labor costs to utilities and overhead expenses, and third party payers placing more constraints on reimbursement qualifications, it’s no wonder that hospitals, health systems, clinics and independent medical practices are watching every penny. Providers strive to make sure that they receive every penny to which they are entitled, but there is still a significant amount of revenue that goes uncollected.
There are many reasons clinics might lose revenue – inadequate insurance coverage from the patient, poor claims denial management, lack of patient engagement, accounts receivable that extend more than 90 days, or lack of understanding about potential government reimbursements. Old technology can make these challenges even worse, with clinics and practices failing to recover thousands and thousands of dollars.
Fortunately, there are also modern solutions to these challenges. Revenue recovery for clinics uses advanced Electronic Health Records (EHR) and Amazon Web Services (AWS) cloud-based applications to help healthcare providers improve their revenue recovery processes. This article looks at five of the most powerful revenue recovery strategies clinics can use to increase their revenue and profitability.
The 5 Tools for Clinic Revenue Recovery
In February 2022, the Medical Group Management Association (MGMA) revealed the results of a poll of 690 members, which found that 60% of medical practices met their revenue goals, while 40% did not. A July report from RevCycle Intelligence reinforced this statistic with a survey which showed that most provider organizations were still behind their healthcare revenue goals, even at the half-way point for the year.
In May of this year, McKinsey & Company published an article entitled, “Rapid Revenue Recovery: A road map for post-COVID-19 growth.” The three steps they recommended to get started on rapid revenue recovery included: identify and prioritize, act with urgency, and develop a rapid-fire agile operating model. They also noted that, “the best companies are moving quickly to enhance and expand their digital channels.” Applying these guidelines to revenue recovery for clinics, advanced EHR software based on a cloud experience can help to quickly implement five powerful revenue recovery strategies:
- Uncover Insurance Coverage: Despite a heavy focus on healthcare insurance in recent years, there is still a great deal of uncertainty at the private practice level in matching patients to insurance coverage. Patients get older and become Medicare-eligible, they change jobs and healthcare coverage, or some use ACA marketplace websites to find low-cost coverage every year. In the worst-case scenario, a patient may not even have any coverage between policy changes. This creates an incredible administrative burden for medical clinic staff as they try to verify coverage and collect the appropriate co-payment at the time of service. Not having the correct insurance information could lead to a drastic delay in reimbursement as the patient and provider go back and forth trying to update coverage information.
Failure to collect the proper co-pay could mean an extensive effort trying to collect the remaining funds from the patient. If your private practice relies on incorrect or outdated patient and insurance information, then your claims process will produce shoddy results. Use a Practice Management System that allows for pre-authorization management, and helps your front office team know more at check-in by electronically confirming eligibility and claim status.
- Manage Denials Efficiently: According to a 2016 RevCycle article, “While some claim denials could lead to significant healthcare revenue declines, the Medical Group Management Association (MGMA) found that approximately 65 percent of claim denials were never corrected and re-submitted to payers for reimbursement. That is just like watching money walk out the door of your practice. Denied claims cannot be ignored; they must be addressed quickly and decisively.
Medical billing software that integrates with your EHR submits better claims in the first place, and then helps your staff more quickly address common denial reasons such as missing or incomplete supporting documentation, insufficient physician credentialing, and utilizing inaccurate codes. Denied claims must be worked efficiently and quickly to help keep cash flow moving.
- Boost Patient Engagement: Providers do not have to be alone in dealing with payers; they can utilise digital patient engagement tools to become partners with patients throughout the process. Prior to check-in, patients can utilize digital technology to update their contact and insurance information, verify that the provider is in their coverage network, and determine what their co-payment responsibility will be. At the appointment, the patient should be prepared to pay that amount. If there is a claim denial, the provider can communicate with the patient through the patient portal to provide any updated information.
- Improve Accounts Receivable: Services rendered that are not covered by insurance are the patient’s responsibility. One key metric is days in accounts receivable, which indicates just how long it takes your independent practice to receive payment for the services it has provided. According to the American Academy of Family Physicians, 30-40 days is the target metric. If a significant percentage of your account receivables fall into the 90-120 day range, there is a deficiency in your billing and collection process, and you need to use advanced software services to more closely follow-up on these amounts.
- Benefits from Government Reimbursements: One thing that will never change is that government reimbursements will keep changing. They changed all through COVID, and will continue to change moving forward. As Medicare implements its payment for value paradigm, your practice can utilize software to track reimbursement levels and requirements.
Key Takeaways for Revenue Recovery Strategies
Revenue recovery strategies are an important piece of your clinic’s survival. PrognoCIS by Bizmatics is a leading EHR company that provides clinical and business productivity software and services to independent medical practices, clinics and specialists. A member of the Harris Ambulatory Group, our cloud-based application (by AWS) is fully integrated with powerful modules including Electronic Health Records (EHR), Telemedicine, Practice Management, Medical Billing, Revenue Cycle Management (RCM), and Patient Engagement tools. Visit our website or call 408-873-3030 to request a demo and learn more about improving your revenue recovery strategies.