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Stephen O'Connor

By: Stephen O'Connor on June 20th, 2014

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The 3 Biggest Reasons Medical Practices Fail to Maximize their Revenue

Medical Billing / RCM

The-3-Biggest-Reasons-Why-Medical-Practices-Fail-to-Maximize-their-RevenueIn a perfect world, medical providers would simply focus on delivering the best possible service to all their patients, and the financial aspects of their practice would take care of themselves. Happy patients and a staff with high morale would be sufficient to ensure an adequate revenue stream.

However, some medical practices could do better with how they handle their business operations in terms of efficiency, denied claims, and unpaid claims. Here are the three biggest reasons why most medical practices typically fail when it comes to maximizing their revenue.

1. Staff Working Inefficiently

Is your medical organization still relying on an antiquated and paper-based system to manage your office and patient information? Your staff will definitely benefit by implementing Electronic Health Records and Revenue Cycle Management, or RCM software.

You can use an EHR application to shave time on such basic processes as verifying a patient’s insurance status, for example, or to set up appointments more quickly and efficiently.

Staffers can easily type in information in the patient’s chart a single time, and the details will be accessible to nurses, doctors, and other professionals whenever they need it. They can even use voice recognition to speak and see their words show up on the screen for fast digital storage with the patient’s chart.

These applications also save staffers time and effort because they reduce the number of mouse clicks and keystrokes needed to enter and update information.

2. Too Many Denied Claims

A key problem with medical practices failing to maximize their revenue comes from having too many denied claims. You will want to use RCM software that includes the ability to view all denied claims and the salient details. Your staff can then quickly make any needed corrections to the rejected claims as soon as they see them.

It’s important that your software makes it easy to switch from ICD-9 to ICD-10. The federal government is requiring medical organizations to switch from the International Classification of Diseases code version 9 to version 10 by October 1, 2015. Adhering to the new code will ensure that you get fewer denied claims.

3. Failure to Adequately Keep Track of Unpaid Claims

Amidst all the record keeping, billing, and scheduling tasks performed by your staff every day, what are team members doing to keep track of unpaid claims? If you don’t stay on top of claims that providers have failed to respond to, you are more likely to lose out on money you’re entitled to.

Medical software with a built-in feature for keeping track of claims will make a big difference for boosting your revenue. You’ll see when you should expect to receive each payment and the current status of each outstanding claim. This will let you spot problems before they persist for too long and can improve your cash flow.

Medical practices have many resources available to them to get on better track with their finances. Once you and your staff take the time to transition from a paper-based system to install and implement EHR and RCM software, you can rest assured that you are doing what it takes to bring in more revenue. You’ll be better positioned to improve efficiency, reduce the number of claims denied by providers, and get better control over your overall unpaid claims.

Key Takeaway:

  • Medical practices sometimes fail to recognize opportunities to boost their revenue stream but can use software to improve the situation.
  • Going from a paper-based system to using Electronic Health Records and Revenue Cycle Management applications will help the staff work more efficiently.
  • Practices can take steps to reduce the number of denied claims with RCM software.
  • It’s crucial for the staff to stay on top of unpaid claims to achieve better cash flow for the practice.



About Stephen O'Connor

As a Director of Digital Marketing at Advanced Data Systems Corporation, Stephen spends his day's planning, writing, & designing resources for the modern healthcare professional. He has a strong affinity for snow crab legs, the ocean, and Rutgers Football.