Is your practice leaving money on the table?

It’s a question every healthcare provider should ask. In the complex world of medical billing, it’s easy for revenue to slip through the cracks. At NatRevMD, we’ve seen it all. In a recent podcast episode, we sat down with one of our own team members, Mandy, to discuss the most common—and costly—medical billing errors we uncover in practices.

Here are five key areas where your practice could be losing revenue, and how to fix them:

1. Unsubmitted Claims: The Vanishing Revenue

You can’t get paid for services you don’t bill for. It sounds simple, but you’d be surprised how often claims are never submitted. Here’s what to watch out for:

• Lost Superbills: Are you still using paper superbills? It’s time to go digital. Paper can get lost, leading to unbilled services.
• Unlocked Charts: When physicians don’t lock their charts, the billing process comes to a halt. Implement a process to ensure all charts are signed and coded in a timely manner.
• Incomplete Coding: A missing diagnosis code or an incorrect E&M code can lead to a claim being rejected or denied. Double-check all codes before submission.
• EDI Enrollment Errors: Electronic Data Interchange (EDI) enrollments connect you with payers. If these aren’t set up correctly, your claims will get stuck in limbo.

2. Paper-Based Processes: Slowing Down Your Cash Flow

In today’s digital age, relying on paper is like choosing a horse and buggy over a sports car. It’s slow, inefficient, and costing you money.

• Lack of EFT and ERA: Are you still waiting for paper checks and explanation of benefits (EOBs)? Setting up Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) will get you paid faster and streamline your posting process.
• Manual Reconciliation: Manually reconciling paper EOBs is a time-consuming and error-prone process. ERAs allow for automated posting, freeing up your staff to focus on more complex issues.

3. Bank Reconciliation: The Missing Link in Your Revenue Cycle

Are you sure that every payment you’ve posted has actually been deposited into your bank account? Without a solid bank reconciliation process, you could be leaking revenue without even knowing it.

• Posting Without Confirmation: Never post a payment until you’ve confirmed that the money is in your bank account. This simple step can save you from a world of headaches down the road.
• Uncashed Checks: We’ve seen practices with thousands of dollars in uncashed checks sitting at the post office. Regular follow-up on outstanding payments is crucial.

4. Undercharging: Don’t Sell Yourself Short

Are you charging enough for your services? If your fee schedule is set below the payer’s allowed amount, you’re leaving money on the table with every patient you see.

• Zero-Dollar Adjustments: If you’re seeing a zero-dollar contractual adjustment on your EOBs, it’s a red flag that your charges are too low. Review your fee schedule and make sure it’s set above the payer’s allowed amount.
• Fee Schedule Analysis: Regularly review your fee schedules to ensure they are in line with your payer contracts. Services like the one offered by TriZetto can help you identify underpaid claims.

5. Eligibility and COB Denials: The Front-End Fix

Eligibility and Coordination of Benefits (COB) denials are two of the most common—and preventable—denial reasons. A strong front-end process is your first line of defense.

• Verify, Verify, Verify: Verify every patient’s insurance eligibility before every visit. This will help you catch any changes in coverage and prevent denials down the road.
• COB Communication: When a COB denial occurs, it’s often because the patient needs to update their insurance information. Use text and email to communicate with patients and resolve these issues quickly.

The NatRevMD Difference

At NatRevMD, we’re more than just a billing company. We’re your strategic partner in revenue cycle management. We dig into the details, identify the root causes of your billing problems, and implement solutions that work. If you’re tired of leaving money on the table, it’s time to talk to the experts.

If you are interested in seeing if you qualify for a free revenue audit, check us out here!