Is Your Healthcare Facility’s Revenue Moving in the Wrong Direction?

The more patients you have, the more revenue you are bringing in, right? Wrong. While you would think more patients should mean you are improving your revenue within your medical practice, this is not the case.

In fact, if healthcare practices are not careful, they could be losing revenue even as more patients come walking through the door. But why does this occur?

Where Does the Money Go?

There are many reasons behind a healthcare facility losing revenue while still seeing a great number of patients, including:

Inaccurate Coding

One of the most common reasons behind a medical practice losing money is inaccurate (or inadequate) CPT coding input.

Health care is always changing. With that, medical billing codes also continually change. Therefore, if the billing professionals within your medical practice are not staying up-to-date on coding, the revenue can be lost due to denied claims or reduced reimbursement.

However, under-coding can play a large part in revenue lost, too. Many times, if the billing department is unaware of what occurred during a patient’s exam or surgery, they can “undercode” for the services used because they just don’t know what exactly went on within the exam room.

It is estimated that a medical practice loses a minimum of $10,000 each year due to only undercoding. Thus, it is vital for the lines of communication to be open within a medical practice, especially when it comes to quarterly coding education and reimbursement protocols.

Poor Billing Practices

Within a healthcare facility, every department needs to follow best practices, especially billing. When poor billing practices occur, the result can take a huge toll on the medical practices’ finances.

Most of the time bad billing happens not because the people within the billing department are purposely making mistakes. But, just like in coding, if your employees are unsure about the what they are supposed to be doing in billing, financial losses in your medical practice can (and will) happen.

It’s critical during the interview process that you are using professionals who are competent in medical billing to fill your positions within the department. In addition, receptionists and other positions should be able to properly know how to file patient insurance and services so that the billing department receives accurate information to help prevent billing issues, as well.

Insurance Plans

Unfortunately, even if you perform the two tasks above well – bill correctly and code accurately – loss of revenue can still occur. How? Because of the insurance plan your medical practices do business with daily.

While some insurance companies are great about their reimbursement practices, other insurance companies will hesitate to reimburse what is due or might have a low reimbursement schedule.

If you happen to work with one of those insurance companies, it is easy for payments due to your medical practice to fall further and further behind in payments until they usually stop paying you altogether, resulting in loss of revenue. Therefore, be careful of the insurance companies you do business with to ensure they are not the reasons behind your loss of revenue within your practice.

Is your business losing money? Contact the professionals at Merem Health to learn about our consulting, outsourced billing, collections, and revenue cycle management services.