The recording of patient encounters and subsequent diagnoses, treatments, and procedures must be accurate to avoid revenue loss. Incorrect documentation can result in services not being billed or being billed at a lower rate than they should have.  

Not assigning the correct CPT and ICD-10 codes can cause issues such as undercoding, which in the case of revenue leakage in a healthcare setting, can have lasting effects on revenue and a patients treatment plan in the future. 

Failure to verify patient insurance eligibility or obtain pre-authorization can result in revenue leakage that could have easily been prevented.  

Furthermore, contractual disputes between medical practices and insurance payers can exacerbate coverage issues. These disputes often arise when there is disagreement regarding the terms of the contractual agreement between the two parties. Disagreements may arise from fee schedules, reimbursement rates, coverage limits, or how contract language is interpreted.  

Underpayments from insurance companies can equally reck havoc on a practice’s financial status. These types of coverage issues can occur when information was not input correctly either on the practice or insurance companies’ side when going through their coding and billing processes.

All types of challenges can result from not adhering to healthcare regulations, billing requirements, or payer policies. 

Legal and regulatory consequences can be very serious depending on the violation’s nature and severity. A practice may face fines, penalties, sanctions, or legal action from healthcare regulatory organizations or government agencies. This may also then lead to a loss of accreditation or credentialing, which can then limit who a practice can work with and what a practice can participate in.  

Public compliance issues can tarnish the reputation of a medical practice. Patients, staff, and the community may lose trust in the practice, which could result in less business and lower income. Rebuilding a medical practice’s reputation can be extremely challenging no matter the compliance issue.  

Bad debt in medical billing is when unpaid balances for healthcare services are not expected to be collected or recovered. This happens when patients are unable to or are unwilling to pay their medical bills.  

Practices often need to collect payment from patients that are causing them bad debt. This process can require reaching out to patient’s multiple times and in some cases, legal action may be necessary. These actions can put a strain on the relationship between the patient and the healthcare provider. 

Being accurate in all revenue cycle areas helps maximize revenue and prevent any loss of revenue. This involves ensuring that all patient information, from patient registration to claims processing and payment collection, is handled with precision and care. The attention to detail throughout the whole patient lifecycle could make or break the financial stability of a practice. 

When a practice neglects to confirm patient information, it risks encountering claim denials or delays in reimbursement. Insurance issues may still arise later, but by taking action now, you can reduce potential obstacles. Take control while you can to minimize future challenges.  

Monitoring days spent in accounts receivable helps practices gauge the efficiency of their cash flow management. By improving or keeping an eye on the turnaround time, cash flow predictability can be improved and ensures there are sufficient funds for related costs.  

Your claims denial rate could point you in the direction of what part of your medical billing process is having problems. For example, you may find a trend that frequent denials are coming from specific payers or certain types of services, which may highlight a need for improvement.  

Working with a user friendly financial dashboard within your practice management software makes keeping track of these important metrics simple.