Revenue Lost in the Administrative Shuffle

Revenue Lost in the Administrative Shuffle

We all know the revenue cycle management (RCM) process is complicated. And launching into that process requires a practice to track patient encounters.

Tracking encounters goes hand-in-hand with submitting claims to insurance, collecting patient co-pays, and collecting patient balances.

But nearly 80 percent of medical practice administrators struggle to keep track of and reconcile patient encounters.

The result of this struggle is a falloff in the crucial step of submitting claims for billing. According to a survey by the Medical Group Management Association, 7 percent of medical claims are never submitted to insurance companies for reimbursement. These encounters get lost in the shuffle. And in that shuffle, money is lost, for medical practices and hospitals alike.

If a practice can’t track an encounter, they aren’t tracking co-pay collections. According to a report by the Advisory Board, 40 percent of copays go uncollected. That adds up to a significant amount of lost revenue.

Co-pays may sound like (financial) peanuts. But to showcase the importance of collecting them, according to a study by the Medical Group Management Association, medical practices actively tracking and collecting co-pays (meaning they collect at least 90 percent of them) see an overall 10 percent or more increase in practice revenue.

The third area where revenue takes a hit when tracking efforts overwhelm staff is patient financial responsibility. When tracking measures are off, 68 percent of these patient responsibility balances are left unpaid, according to a study by TransUnion Healthcare.

Overlooking insurance submissions, co-pays, and patient financial responsibility balances are three areas that lead to substantial lost revenue. All of these are avoidable, however, and all originate with the ability or inability to track and reconcile patient encounters.

So, how does a practice sort it out?

It’s human nature to become complacent, and do things “the way we always did them.” But with today’s complexities, it’s time to set aside the paper and spreadsheets.

The first step is implementing more sophisticated tools and software to track, reconcile, and streamline the billing and claims process.

We’ve talked about affordable technologies available today that can track which patients were seen by which providers, on which days, and at which location. It’s a logistics dream for administrators, practice stakeholders, and finance teams, and an easy way to increase the number of claims that get sent in to insurance for reimbursement.

The second step is to prioritize the collection of co-pays in order to maintain – or improve on – a healthy financial position. Technology that gives a heads-up on the front end of an appointment, with respect to eligibility, prior authorization, and co-pay, prepares staff to collect what is owed when the patient is standing directly in front of them, stopping the wasteful cycle of mailing out continual invoices, which remain unopened and unread.

The third step is to collect patient responsibility balances – and close the gap on the almost 70 percent that remain unpaid. When encounters aren’t lost in the shuffle, patient balances aren’t lost either. This is an enormous financial win for providers.

By addressing these everyday struggles on the front end, with readily available tools and the RCM technologies offered today, medical practices can improve their financial position and provide better quality care to their patients.

Programming note: Listen to Susie Vestevich report this story live today during Talk Ten Tuesdays, 10 Eastern, with Chuck Buck and Dr. James Kennedy.


Susie Vestevich, JD

Susan A. Vestevich, JD, is the chief operations officer for Tia Tech (USA). She focuses on disruptive healthcare technologies and solutions, including new program rollouts as well as physician/client engagements.

Related Stories

Lessons Learned from ACDIS

Lessons Learned from ACDIS

Today and in two weeks, I am going to share some tips I picked up at the ACDIS National Conference in Chicago, May 9 through11.

Read More

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Mastering Good Faith Estimates Under the No Surprises Act: Compliance and Best Practices

Mastering Good Faith Estimates Under the No Surprises Act: Compliance and Best Practices

The No Surprises Act (NSA) presents a challenge for hospitals and providers who must provide Good Faith Estimates (GFEs) for all schedulable services for self-pay and uninsured patients. Compliance is necessary, but few hospitals have been able to fully comply with the requirements despite being a year into the NSA. This webcast provides an overview of the NSA/GFE policy, its impact, and a step-by-step process to adhere to the requirements and avoid non-compliance penalties.

Mastering E&M Guidelines: Empowering Providers for Accurate Service Documentation and Scenario Understanding in 2023

Mastering E&M Guidelines: Empowering Providers for Accurate Service Documentation and Scenario Understanding in 2023

This expert-guided webcast will showcase tips for providers to ensure appropriate capture of the work performed for a visit. Comprehensive examples will be given that demonstrate documentation gaps and how to educate providers on the documentation necessary to appropriately assign a level of service. You will gain clarification on answers regarding emergency department and urgent care coding circumstances as well as a review of how/when it is appropriate to code for E&M in radiology and more.

June 21, 2023
Breaking Down the Proposed IPPS Rule for FY 2024: Top Impacts You Need to Know

Breaking Down the Proposed IPPS Rule for FY 2024: Top Impacts You Need to Know

Set yourself up for financial and compliance success with expert guidance that breaks down the impactful changes including MS-DRG methodology, surgical hierarchy updates, and many new technology add-on payments (NTAPs). Identify areas of potential challenge ahead of time and master solutions for all 2024 Proposed IPPS changes.

May 24, 2023

Trending News