Avoiding Four Common Pitfalls in Revenue Cycle Management

As Coker works with providers and groups of all types to optimize their revenue cycle operations, we encounter consistent barriers to effective revenue cycle management (RCM). Listed below are some of the common RCM pitfalls and how you can avoid them.

1. Ineffective front desk processes: Clean, current, and correct claims start with the front office where it’s critical to capture accurate patient demographics, insurance information, and verify eligibility for every visit. Many billing offices waste significant time on rework and denials that could be avoided with consistent front-end processes and guidelines. Errors lead to delays and ultimately lost revenue, in many cases, particularly related to point-of-service collections. Establish standard processes and expectations for front office staff as well as effective feedback and communication with the billing office. Then, reinforce these processes with training and accountability.
2. Lack of clarity related to payer contracts, reimbursement, and fee schedules: It’s imperative to understand your negotiated contract language and reimbursement rates so that variances in expected payments can be identified quickly to avoid unnecessary loss of revenue. Review existing contracts and create a reference matrix that can be used to manage fee schedules, chargemaster, and training.
3. Inefficient system utilization: Technology is often the scapegoat for inefficient processes, but it can also be a legitimate barrier to improvement. Failure to update technology and systems results in redundant (often manual) workflows, staffing inefficiencies, charge entry delays, and slow payment processing. Review system capabilities/functionality, vendor contracts, and potential upgrades that could help optimize your existing structure or inform new IT investment decisions.
4. Lack of timely and reliable performance metrics or targets: Some organizations do not have a working knowledge or access to basic RCM performance data or metrics, but even those that do often struggle to communicate performance both timely and consistently. Reliable metrics are essential for setting targets across all RCM personnel and leaders, which also serves as the foundation for accountability and ownership. Choose a few key metrics or performance indicators that your organization can track, and then develop a dashboard or consistent reporting mechanism so leaders and staff can make timely operational decisions and be held accountable.

These common pitfalls are fundamental in concept but complex problems to solve for many organizations. Improving in these areas typically has a tangible and immediate financial return, which should justify the investment in solutions. We recommend starting with an RCM assessment to determine your areas of opportunity and the potential financial benefit to your organization.We would love to hear about your pitfalls and how you’re addressing them. If you’d like to learn more about how our physician services team can support your RCM, please contact us.