Are Slow Leaks in RCM Draining Your Practice’s Revenue?

Unpaid copays and insurance underpayments — two issues that often give practice owners nightmares. It’s easy to assume that practices with solid revenue cycle management (RCM) processes in place would be able to universally avoid these problems. However, the reality is that even those that do have efficient systems sometimes suffer from the revenue “slow leaks” mentioned above.

Insurer underpayments: So easy to miss, so hard on your bottom line.

If your practice is like most, you have contracts with multiple insurance providers, and odds are that each one is at least a little different than the others. In other words, the exact same procedure may be reimbursed at a different rate depending on the insurer, making it incredibly easy to miss an underpayment if each claim isn’t closely scrutinized. In fact, the American Medical Association’s National Health Insurer Report Card stated that insurers pay the correct contracted rate as little as 62% of the time.

At the end of the day, the onus is on the practice or service provider to dispute the claim and follow up until it’s resolved. This is one area in which a little extra training for back-end RCM staff can absolutely pay off. Ensuring that they are aware of the rate at which these underpayments happen (frequently!), know the true contracted rates, and understand the course by which dispute and resolution need to happen in these cases can go a long way toward plugging this very common revenue leak.

When patients don’t pay.

While a lot of attention is paid to collecting patient responsibility for procedures and other services, one of the most costly drains on revenue is actually patients’ failure to pay co-pays. When it comes to this issue, the key is remembering that there truly is “no time like the present” to process a co-pay payment.

Again, a lot of this goes back to staff training, this time, on the front end of RCM. Ensuring there is a process in place at initial intake where every patient is asked how (not if) they plan to take care of their copay today is essential to consistent collection. One way to take some of the pain out of this process for patients is to let them know exactly what their co-pay will be at the time they make their appointment. Knowledge is power, and if patients are prepared, they are less likely to balk at handing over their credit card when the time comes to do so.

Via provides a stopgap to keep revenue flowing smoothly.

While taking steps to plug potential revenue leaks can help practices protect their bottom lines, there are still financial gaps that can occur. This is why many have chosen to integrate Aquina’s Via solution into their RCM. Via allows insurance claim reimbursements to be expedited, so even when patients are slow to pay or insurers underpay claims, a practice’s overall finances can remain healthy. With integration already in place with leading EHR providers such as athenahealth and Kareo, getting started is easy. Contact Aquina Health today and find out how.