Revenue Leakage: What Is It and How To Stop It

Healthcare practices receive most of their revenue as reimbursement for services already performed. As a result, revenue leakage leaves your practice underpaid, making it harder to serve your patients well. 

Here is what your practice needs to know to identify and prevent revenue leakage. 

What Is Revenue Leakage? 

Revenue leakage occurs when your practice provides a service but does not receive payment. Claims denials, underpayments, and bad debt are all forms of revenue leakage. For specialists, revenue leakage also happens when patients are referred to you but have yet to make an appointment.

A leaky revenue cycle may leave your practice scrambling to provide more services to increase revenue. However, increasing throughput can harm the patient experience and leave providers burned out. Fixing revenue leakage is a great way to boost revenue without changing the patient-provider relationship. 

Why Does Revenue Leakage Happen?

Revenue leakage often goes unnoticed. Accounts may sit in non-payment status for months before your staff members have time to conduct follow-up. Claims denials may go unappealed. Many health insurers set deadlines for claims and appeals, so even inadvertent delays can have significant financial consequences.

Revenue leakage is a sign of poor revenue cycle management. Unfortunately, without the tools to monitor and manage their revenue cycle, many practices accept high claims denial and bad debt as the cost of doing business. However, with a few key changes, your practice can reduce revenue leakage and get on firmer financial footing. 

7 Tips to Stop Revenue Leakage

Revenue leakage is not inevitable. Here are seven tips to prevent your practice from inadvertently losing revenue. 

1. Always Verify Insurance Information

Patients may change their insurance carrier, coverage, or contact information between visits. Billing the wrong insurer, misstating patients' identifying data, or even entering typos can cause denied claims. In addition, tracking down and correcting insurance information after an office visit can be time-consuming and costly. 

Luckily, your practice management system can help your practice keep insurance information up-to-date and accurate. For example, your practice can implement electronic check-in procedures that require patients to verify and update their insurance and contact information. Patient portals and check-in kiosks can also eliminate paper check-in, reducing potential data entry errors. 

2. Collect Cost Sharing Upfront

Many patients have copays or coinsurance for office visits. Billing for this cost-sharing after the fact makes it difficult to collect payments. Therefore, your practice can reduce unpaid cost-sharing by collecting copays and coinsurance during check-in. Tools like NextGen Patient Portal can help patients estimate their costs when scheduling appointments, thus eliminating surprises. 

3. Use Electronic Referrals

A cumbersome referral process can cause revenue leakage in large or multi-specialty practices. For example, when a patient is referred to a specialist but fails to make an appointment, the specialist misses out on revenue.

Electronic referrals ensure that the receiving practice is aware of the referral and can follow up with the patient to schedule an appointment. Your practice can also use tools like NextGen's Patient Portal to help patients track referrals and make appointments online. 

4. Submit Clean, Timely Claims

Insurance claims are your practice's most important source of revenue. Therefore, submitting accurate, on-time claims can significantly improve your finances. Hiring a solid team of medical billing specialists or outsourcing your medical billing can also boost your revenue and save you time.

Your EHR and EPM system is a valuable resource for coding and billing. In NextGen, you can build a claims library of clean claims to help your medical billers check for errors. And, with tools like NextGen's Background Business Processor, you can automatically scrub claims or batch and submit them overnight to reduce strain on your computer systems. 

However, your practice should rely on more than just your medical billing staff to scrub and submit claims. You also need office visit workflows that encourage providers to code accurately. Your EHR system can help with reminders and prompts to promote complete coding and documentation. In addition, training and workflow redesign can help reduce uncertainty and boost productivity if your providers struggle to manage billing tasks.

5. Keep Track of Your Accounts Receivable

Accounts receivable aging is an essential measure of your revenue cycle health. For optimal results, your medical billing staff should follow up on any accounts outstanding for 50 days or more. If some insurers consistently fail to submit timely payments, your practice should reach out to negotiate a solution. 

You can also integrate your general ledger system with your EHR to enable better tracking of accounts receivable. And if you use NextGen's EHR and EPM, tools like TempDev's Revenue Cycle Dashboard let you track accounts receivable aging so you can identify your problem accounts and follow up. 

6. Work Through Denied Claims

Denied claims are common. Many practices fail to revise and resubmit these claims, leaving significant revenue on the table. Your medical billing specialists should examine all denied claims to determine the reason for denial and identify an appropriate approach to resubmission. 

Your EHR and EPM system can help your billing staff stay on top of denials. Tools like TempDev's Revenue Cycle Dashboard NextGen EPM Report provide an overview of claims denials, illuminating denial rates and common reasons for the denial. Armed with this information, your practice can improve workflows and coding practices to reduce denial rates in the future. 

7. Make It Easy for Patients To Pay 

Health insurance can be very confusing for patients to navigate. Between copays, coinsurance, deductibles, and denials, patients may not know how much they have to pay or when. And mailed bills can easily become lost or forgotten. Your practice can reduce revenue leakage from patient non-payment by making it easier for your patients to pay their bills. Offering online payment options through a patient portal makes bill pay convenient. Patient payment plans can also be a great way to protect your revenue while increasing patient satisfaction.  

How TempDev Can Help with Revenue Leakage

TempDev's expert revenue cycle management consultants can spot revenue leakage and help you develop a plan to stop it. Through TempBill, TempDev also offers revenue cycle outsourcing and medical billing support so you can focus on your core mission — providing excellent patient care. 

Call us at 888.TEMP.DEV or contact us here for help stopping revenue leakage.