Every women’s health practice leader knows that effective revenue cycle management (RCM) is the backbone of practice success. When RCM starts to fall off the tracks, cash flow follows suit. However, what many don’t realize is that poor RCM not only fails to capture new revenue opportunities but also drives up the cost of collecting the revenue you’re owed — culminating in an inefficient and unprofitable revenue cycle that drains practice resources.
Identifying Revenue Loss Within RCM Workflows
Recognizing a faulty revenue cycle is simple — all you have to do is watch how your bottom line changes over time. It’s far more challenging, however, to diagnose why your revenue cycle isn’t performing optimally. Take denial rates, for example (a primary driver of revenue loss). For the average practice, the denial rate sits at approximately 20% — much higher than the industry benchmark of 5% to 10%.1 However, the picture is much larger than a simple metric. Looking deeper, we can narrow down denial-related revenue loss to two key factors:
- Inefficient front-end RCM. Almost half of all denials come from front-end RCM issues, with 26% specifically beginning in the registration and eligibility verification phase, before patients even get to see their provider.2 These steps are often the first to get overlooked when your billing team gets overwhelmed.
- Errors during claims submission. Over 17% of denials are attributable to missing or invalid claim data, which can start with incomplete provider documentation, inaccurate codes, or delays in billing that result in incomplete or inaccurate data.2 A busy billing office is especially prone to missing critical details that impact claim approvals.
The story doesn’t stop there — billing teams should always try to rework denials to reclaim revenue, but this process can be incredibly costly. Practices spend an estimated $25 to rework just one denial, and hospitals will spend over seven times that amount.1,3
To put it simply, the costs of a denial are just too high for most organizations, meaning it’s essential to get claim information right the first time. Spending the time and resources to submit clean claims will help you avoid wasting countless hours trying to get it right the second time. However, most OBGYN billing teams don’t have the time to triple-check details through every stage of the revenue cycle. In order to protect against major losses, more practices are turning to an outsourced partner like Accurio.
How Outsourcing Maximizes Cash Flow and Minimizes Risks
For billing teams that lack the bandwidth to stay on top of revenue cycle operations, leveraging an outsourced OBGYN billing solution is a game changer for practice growth. With a whole team of women’s health RCM experts dedicated to your revenue cycle — and not performing several other functions throughout your office — you benefit from several sets of trained eyes focusing only on submitting accurate claims and collecting full reimbursement.
Partnering with Accurio provides total peace of mind that your revenue cycle is in safe hands that:
- Capture every revenue opportunity
- Minimize claims errors and delays that lead to denials
- Reduce the cost of correcting claims and reworking denials
- Help your team focus on tasks more relevant to patient care
With a partner like Accurio on your side, managing your revenue cycle becomes easier and more cost-effective than ever. Schedule a consultation to learn more about how our women’s health revenue cycle solutions can help you cut the costs of running your practice.
Sources
- Mills, T. (2019, September 9). Why Getting Claims Right the First Time Is Cheaper than Reworking Them. Physicians Practice. MJH Life Sciences. https://www.physicianspractice.com/view/why-getting-claims-right-first-time-cheaper-reworking-them
- The Change Healthcare 2020 Revenue Cycle Denials Index. (2020). Change Healthcare. https://www.ache.org/-/media/ache/about-ache/corporate-partners/the_change_healthcare_2020-revenue_cycle_denials_index.pdf
- Gooch, K. (2017, June 26). Denial Rework Costs Providers Roughly $118 per Claim: 4 Takeaways. Becker’s Hospital Review. https://www.beckershospitalreview.com/finance/denial-rework-costs-providers-roughly-118-per-claim-4-takeaways
