There are a number of common reasons why insurance claim payments are denied. The most common reason is missing or incorrect information, like demographic information, procedural codes, or diagnosis codes. The other main thing is prior authorization being not conducted. Some other causes for claim denial are medical necessity requirements not reached, procedures not covered (eligibility issues), payer processing errors, the provider not in contact, and coordination of benefits. Denials are the main issues for healthcare practices because they can lead to loss of revenue and reimbursement, as well as pressure on billing staff increases to correct the errors and resubmit the claim. Due to Revenue Cycle Management denial rates can be decreased.

A particular Revenue Cycle assessment can help your practice avoid claims denials and make sure that you have regular reimbursement for services provided. One of the most important benefits of reducing denials for your practice is increased profitability. Your Revenue Cycle assessment includes few elements that are described below:

In order to recognize your revenue cycle, you must have a strong grip on your practice’s presentation measures. Once these are set on, standard them against industry best practices. Best performance includes net collection rate, days in accounts receivable, and more. This type of strategy will allow your practice to connect opportunities for improvement moving forward.

When calculating your revenue cycle, you should spend time to review the process as well. Your revenue cycle includes many things, it starts with initial registration and ending with insurance follow-up. Make sure that process is going step by step that will allow you to analyze work flow and the time it takes to complete each step of the process, which can shed light on areas to improve.

Some specific tools are utilized in your practice’s revenue cycle. You should focus on tools and resources that are used for different task in the industry. Communicate with your staff about how they feel about the process is going and which tools are most helpful to them.

You have to focus on your practice’s staff volume as well. Discuss operations with your staff and determine how many individuals are required for each step of the process, as well as how much time is required for other factors such as specialty, patient demographics, and technology required. You can also utilize your time by guiding your staff and their needs moving forward, influenced by the new plans you create.

A broad and wide review of your revenue cycle can help your practice greatly reduce your number of insurance claim denials, increase your cash flow, and overall practice performance. At MaxRemind, our team specializes in revenue cycle management for orthopedic and radiology practices and we will help you for your success. Our Revenue Cycle management services aim to speed up turnaround, avoid refilling cost and delays in reimbursement, and increase cash flow. We also perform analysis for your best practice, so you can get insights into what to address and how to make the proper changes moving forward. We proudly offer a variety of practice management services with the goal of bringing your practice to the high level of industry.