Despite the chaos of ICD-10 conversion, there are many ways that providers can minimize claims errors and denials. Clinical and financial workflows have the greatest impact on revenue cycles due to outdated processes, inadequate communication and lack of follow through. Therefore, it is important to anticipate the most probable mistakes and optimize internal workflows in order to avoid revenue losses.
Archaic procedures and human error are major causes of revenue leakage on the clinical side. Human error occurs when the wrong code is recorded or the clinician performs a procedure that isn’t covered, which means major losses in payments by patients and their insurers. Outdated communication techniques can cause a loss in potential patients and consequently more revenue loss. For example, a study by the Journal of American Medicine from 2009 shows that 46% of referrals faxed to specialists within the network did not result in a patient appointment.
On the financial side, revenue leakage can be caused by late filings, missing authorizations, inconsistent collection follow-up, or employee mistakes. Aligning organizational goals is critical to alleviate these problems by forming an ongoing informatics team made up of key employees from IT, finance, and major workflow areas. Using analytics to uncover flaws in revenue cycles can help reduce miscoding, overcharges and readmissions, while increasing collections and referral revenue. By adopting a team approach, using analytics, and reviewing processes and procedures, healthcare organizations can effectively stabilize their revenue cycles and prevent revenue leakage.
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