Preventing Revenue Leakage in Your Practice - PowerPoint PPT Presentation

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Preventing Revenue Leakage in Your Practice

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Learn how to plug revenue leakage in your healthcare practice and ensure steady cash flow. Find out major issues and solutions in this blog. – PowerPoint PPT presentation

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Title: Preventing Revenue Leakage in Your Practice


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Preventing Revenue Leakage in Your Practice
Revenue leakage is nothing but the lost
opportunity to collect money earned from your
practice. The reason for revenue leakage can be
rejected claims, unbilled claims, unbilled
procedures, credentialing-related denials,
underpayments, and outstanding patient balances.
For any healthcare practice, medical billing and
revenue leakages could result in significant loss
because of long payment cycles. There are
notable loopholes in the overall medical billing
process that should be monitored to ensure a
steady cash flow, which will provide financial
stability to your practice. In this article,
well outline the major issues of revenue leakage
and outline our solutions to them in order to
improve your practice collections. Key Causes of
Revenue Leakage in Medical Billing 1. Rejected
Claims The majority of claims are rejected due
to wrong patient demographics and insurance
details mentioned in the submitted claims. Claims
will also get rejected if a patient changes their
address or contact number with the insurance
company and doesnt update the providers office.
Train your front desk staff to capture patient
demographics and insurance details accurately
while handling patients with care and empathy. 
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Preventing Revenue Leakage in Your Practice
2. Unbilled Claims Claims can remain unbilled or
stuck in medical billing software due to
scrubbing errors. Different medical billing
software provides scrubbing features where the
software will highlight errors in claims before
submitting. Claims stuck due to scrubbing errors
never reach the clearinghouse and can remain
unbilled. Unbilled claims can be identified by
comparing reports of patients appointments,
procedures performed and the number of claims
submitted. 3. Denied Claims Denial management
is a crucial step in revenue cycle management and
requires to be handled with utmost expertise.
Submitting an accurate claim is not
sufficient, denial management will ensure that
all submitted claims are getting paid and in case
of denials, appeals with the appropriate
documentation can be submitted. Hire a
professional team who can resubmit denied claims,
understand the reasons behind denials, and create
a corrective process to prevent future denials
due to the same issues. 4. Unbilled Procedures
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Preventing Revenue Leakage in Your Practice
Sometimes physicians leave some minor procedures
unrecorded with the assumption that these are
unbilled procedures. A detailed discussion
between physicians and coders could help to
distinguish between billed and unbilled
procedures. You should have an expert medical
coder in your team who can help to identify
billed and unbilled procedures. Educating
physicians on billable procedures decreases
instances of unbilled procedures and improves
revenue. An expert medical coder usually helps to
identify revenue leakage due to unbilled
procedures after having a detailed discussion
with the physician.
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Preventing Revenue Leakage in Your Practice
5. Credentialing-related Denials Whether you are
a small practice or a large healthcare
organization, ignorance towards provider
credentialing could become a prime source of
revenue leakage. Ignorance towards
non-participation of providers with certain
health plans can increase denials. You should
have a credentialing expert in your team who will
handle evolving requirements and regulations
related to provider credentialing and payer
enrollment. This function is necessary to run a
profitable practice and deliver quality patient
care.  6. Underpayments Most physicians are not
aware of a fee schedule for various procedures.
Different payers may pay you differently for the
same procedure as per your contracting agreement.
Underpayments can be avoided by planning and
revising your fee schedule with various payers.
At the time of contracting, its not mandatory to
accept the payers fee schedule, you can
negotiate. Seek expert assistance in payer
contracting and in defining your fee
schedules.  7. Outstanding Patient Balances
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Preventing Revenue Leakage in Your Practice
Your practice must build a seamless patient
balance management process consisting of timely
reminder calls/texts to patients, electronic
payment methods, and flexible payment plans to
ensure maximum reimbursements. Prior eligibility
and benefits verification will state the
patients insurance coverage, co-pays, or
deductibles. You can collect more patient
responsibility at the time of patient visits with
a streamlined eligibility and benefits
process. Medical Billers and Coders (MBC) can
help you implement effective RCM strategies to
prevent revenue leakage and boost your practices
financial health. To learn more about how we can
support your practice with expert billing
solutions and revenue cycle management, reach out
to us at info_at_medicalbillersandcoders.com or
call 888-357-3226. FAQs 1. What is revenue
leakage in healthcare? Revenue leakage is the
lost opportunity to collect money earned due to
issues like rejected claims, unbilled procedures,
and underpayments.
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Preventing Revenue Leakage in Your Practice
2. Why do claims get rejected? Claims are often
rejected due to incorrect patient demographics or
insurance details, like outdated address or
contact information. 3. How can I prevent
unbilled claims? Regularly compare patient
reports, procedures performed, and claims
submitted to identify unbilled claims stuck in
the system. 4. What causes credentialing-related
denials? Ignoring provider credentialing can
lead to denials, especially when providers are
not properly enrolled with certain health
plans. 5. How can I reduce outstanding patient
balances? Build a seamless process for timely
reminders, offer flexible payment plans, and
verify eligibility and benefits to collect
co-pays and deductibles upfront.
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