How To Improve RCM For Your Medical Practice

How To Improve RCM For Your Medical Practice

With the introduction of EMR and advanced practice management software the general belief is that the standards of billing and collection will be like never before and every claim should be billed out accurately and collected upon in a timely manner. Unfortunately, according to industry sources, independent medical practices are still leaving as much as 30% potential revenue on the table due to the inefficiencies in their billing and collection process. This happens because, the rejection and denial rate is still too high and almost 50% of denials never get re-worked resulting in 5-7% loss of potential revenue. When you have too many denials your revenue can pretty easily get locked in the Accounts Receivable and that can have serious impact on your cash flow.

With the cost of running a medical practice constantly going up and the continued trend of shrinking reimbursements, it has become impossible for any practice to afford leaving money on the table. If you are a practice owner or practice administrator, and you suspect your practice is leaving money on the table, you should get a comprehensive review of your billing and coding done. Usually this analysis can cost you anywhere between $2000-3000, and that price it is still advisable for you to get this analysis done because you may be losing this much money every month. At Cosentus we constantly keep finding ways to give back to the community, so we offer a Free comprehensive analysis of your billing and coding.

We not only answer all your questions about your billing and coding, but at the end of the analysis we also give you a road map for increasing your revenue. Again, this is totally free, no obligations! You can go to our website or just click the link below and get your analysis in less than 60 seconds.

Get Your Free Comprehensive Billing and Coding Analysis

Cosentus is a leading provider of optimized medical billing services. We are one of the only few truly multi-specialty medical billing company. No matter what your area of expertise is, we can service ASC, Anesthesia, Orthopedics, sports medicine and pain management, women’s health, neurology, radiology including interventional radiology, cardiac etc with equal efficiency. We have been serving our clients for 19 years now and take a lot of pride in transforming their revenue cycle inside out and providing the much-needed boost to their cash-flow.

If you still handle your own billing or outsource to an out of the box kind of medical billing company, we have put together a list of 4 best practices that you can implement to optimize your medical billing and significantly improve your practice cash flow.

Perfect Synergy Between Front-end and Back-end Operations

Healthcare revenue cycle can be split into front-end and back-end operations. Greater the synergy between these two, the more seamless your billing and collections will be. Front-end operations generally refers to smart scheduling of patients, registering new patients, taking authorization, checking eligibility and collecting other important information, while the back-end operations refers to optimally coding the services rendered, sending claims out, working rejections, tracking claims and working denials, etc. Both are generally worked by separate set of people, however each person involved needs to have a good understanding of the entire process for them to be able to gather and process information in the best possible manner.

Breaking the barrier by cross training employees is a smart way to make your revenue cycle seamless. If you outsource to a medical billing company, you can also ask your billing vendor to help out with organizing your front-end operations. you need to have a clearly defined workflow for the front desk. Make sure you are collecting prior balances before giving new service to the patient. Periodic retraining of the front desk employees is highly suggested. It is really important that these employees are well versed with your scheduling and EMR systems, as they are the ones who also trigger off your billing process.

A loose front desk operation on the other side can result in loosing patients, increasing bad debt, loosing revenue and increased cost of collections. Fine tune your front desk operations and you are guaranteed to have 5-15% additional revenue.

Track Revenue Cycle Management

You can’t manage what you haven’t measured. Data should drive a revenue cycle and healthcare is no different. Data can not only clearly point out bottlenecks in accurate and timely reimbursement, it can also tell you about the financial well being of your practice and what you can expect.

Tracking revenue cycle through key performance indicators has become quintessential for a medical practice. If you outsource your billing, your billing service should be able to track these parameters for you and provide you with an easy to comprehend dashboard. If your billing service does not want to share this information with you or does not put together a dashboard for you, no prizes for guessing why!

We believe tracking the following parameters are absolutely necessary for any practice to maintain a profitable revenue cycle.

  • Days in accounts receivable – This indicates usually how long it takes for you to be reimbursed, higher the days in accounts receivable the messier the cash-flow will be. Depending upon your area of medical expertise the preferred days in AR would vary, however it should always stay within 50 days and a healthy trend is for the days in AR to be between 28-35 days.

5 Tips To Improve Days In Accounts Receivable

  • Clean claims submission – With the technology available today, your clean claims submission should be over 98% and if it is not, you got to ask questions.
  • Claims Denial Rate- This is tracked to measure how effective your coding and billing processes are. Your denial rates should be under 6%. That said in our experience about 65% of the practices have 14% or more denials, some even have over 25% claim denials. This is why you need to outsource your billing and outsource to a billing service like Cosentus, we consistently keep your denial under 6% and therefore ensure your cash-flow is always profitable.
  • Denials Write off percentage – According to industry sources, 50% of all denials are never worked and eventually a vast percentage of these are written off. This is your money, you have worked really hard to deliver patient care, so the write off should be minimal and only when necessary. That said not all denials could be disputed, so you need a well-defined dispute strategy. For more information on an effective denial management strategy and how to implement preventive denial management read our blog:

Preventive Denial Management = Sustained Cash-flow

  • Cost to Collect- The more efficient your front-end and back-end billing process is, the lesser would be your cost to collect. So, if your cost to collect is higher than expected, you need to fine tune the processes involved.

Prevent Charge Leakage

Missing out on charges is the last thing you want. It can cost you revenue and eat into your profit margins.

Often times the reason for charge leakage is incomplete documentation. Make sure that you take time to completely document every service provided. Most commonly missed charges are X-rays, interpretation, labs, DME, Gait training, injections etc. These are all payable services and every time you fail to document one of these, you are leaving money on the table.

It is also critical that you billing service has a strong charge reconciliation process in place to ensure they are billing out every charge. Similarly, it is also equally important to pay attention to how the additional services (apart from E&M) are being paid by the payers. Some payers pay so minimal for medicines that you may actually be paying more to procure the medicines than what is being reimbursed to you. Periodically reviewing your charges for payments is highly advisable. Your billing service should be able to provide you with this analysis and relevant reporting.

Or talk to Cosentus, we understand your needs!

Patient Financial Responsibility

Insurance plans with high out of pocket for the patients are becoming increasingly popular. In exchange for a low premium, patients assume greater financial responsibility for their healthcare bills.

This trend of patients shouldering more healthcare costs has made it imperative for medical practices to manage patient financial responsibility better. Surveys show that in 2017 nearly 62 percent of patients with bills under $500 did not clear their dues. And unfortunately, the number of patients who do not pay their bills is on the rise.

Late payments and unpaid bills directly affect the revenue cycle of a medical practice. Not only is payment not received, but staff must spend valuable time and resources on following up with patients in an effort to collect overdue payments.

To address patient financial responsibility, your can implement the following strategies in your revenue cycle:

  • Offer multiple payment options at the point-of-service and pre-service
  • Offer financial estimates pre-service

The ability to offer pre-service price estimates is key, say experts. Surveys show that patients are more likely to meet their healthcare financial obligations if they receive a cost estimate upfront. Software tools are available to medical practices to prepare these cost estimates. These tools rely on historical data to create an estimate of allowable expenses for a specific procedure by a specific payer.

To boost point-of-service collection from patients, medical practices should enforce a policy of credit card information on file. This policy has shown dramatic results at some organizations which saw a nearly 30 percent drop in accounts receivable within six months of implementation.


Owning and running a medical practice is hectic as is, on top of that managing a profitable healthcare revenue cycle could be too much of an ask. You need a billing partner that you can rely upon to consistently help you maintain a profitable cash-flow. Cosentus is on of the only few Medical Billing Companies that offers performance guarantee in service level agreements. You don’t deserve just another, “out of box” billing company, you need a Different Kind of Billing Company!!

Choose Cosentus, see the change, feel the difference!

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