Revenue Cycle Management Blog | GroupOne Health Source

5 Hidden Ways Your Medical Practice is Losing Revenue

Written by Toshya Griffin, CPC | June 17, 2015
According to recent studies, approximately 25%-30% of all medical practice income is lost due to incorrect coding, underpricing, missed or never submitted charges, and nonexistent or improper follow-up. Physician practices have to have a comprehensive and strategic approach to medical billing that involves a skilled personnel mix, from those who schedule appointments to those who follow up with insurers about denied claims. Many practices have switched or are switching to electronic health record (EHR) systems, expecting them to solve medical billing problems.

While EHR solutions can accomplish a lot of initiatives when chosen and implemented well, alone they aren't a panacea for medical billing problems. And it's not always obvious why revenues are falling, which can be frustrating. Here are 5 hidden ways your medical facility could be losing revenue.


1. Features of Some Free EHRs Can Actually Drive Patients Away

Free EHR systems can be tempting. Typically paid for by ads, these systems may seem like an obvious solution for a practice that needs to both raise efficiency and control costs. However, if you're not careful in choosing and implementing a free EHR, features you're not aware of could turn patients off.

Some systems, for example, email product reviews to patients in emails that appear to be directly from the doctor. Doctors may not be aware this is happening. Patients concerned about what is being done with their data may find such features off-putting enough to make them change providers.

2. Not Syncing Maintenance Meds With Patient Follow-Up Visits

Electronic prescribing can be a tremendous time-saver, but only if patients understand how it works and doctors try to synchronize follow-up appointments with a patient's need for refills. If follow-ups and prescription refills don't coordinate time-wise, your practice may receive too many phone calls for refill requests, placing added stress on your office staff's (and your) time.

But when follow-ups coordinate with refill schedules, your staff will have to field far fewer such phone calls, freeing up their time for more revenue-positive tasks.

3. Overstaffing After Successful EHR Implementation

It only makes sense to increase staff during the switch from paper records to an EHR system. The process itself is major and requires more hands. Plus you will probably continue to operate your practice during the transition. And once everything is installed, there will be a period where everyone is learning the new system and how it meshes with practice workflows.

But once the transition is complete and everyone is trained and comfortable, you don't need to maintain those high staffing levels you had during the changeover. You should have gained enough efficiencies that you won't need some of the staff you had when records were on paper.

4. Too Many No-Shows

Having a policy for charges for repeated no-shows is one way to discourage them, but if your practice experiences a lot of no-shows, you need to determine why that is and how to address it. Your EHR system may include an automated appointment reminder feature, and if so, you should use it.

Reminders by phone and text message are popular and effective. Timing reminder calls is important too. If your office calls someone at the end of the day to remind them of an appointment and that person doesn't pick up, they may try to call to reschedule or cancel after your office closes, ultimately resulting in another no-show.

5. Claim Rejection Rates Are Too High

ICD-10 coding could cause a drop in first-pass claim rates while denial rates could jump an estimated 100 to 200 percent in the early stages of the transition to ICD-10. If your claim rejection rates are high now then you are going to extremely overwhelmed with rejections with ICD-10.

Figuring out why your claims are being rejected now will help you take action to prevent future rejections and have a successful ICD-10 transition. Ask yourself if rejected claims are mostly attributable to one insurer? Do they have something in common, such as a particular diagnosis or procedure code? Are you able to successfully appeal the denials? Answering these questions will help you investigate the true cause of rejections and see where your revenue isn't performing.

Practices that are losing money may have inefficiencies that could be hidden. There are many hidden ways revenue can drain from a practice. Understanding where your practice is losing revenue can help you determine a strategy and process to fix the issues before it is to late.