Important Healthcare Revenue Cycle Risks to Avoid in 2019

April 1, 2021
April 1, 2021

As we begin to prepare for 2019, it is important to pay attention to industry predictions about expected developments in the near future for healthcare. One such source, a recent article in RevCycle Intelligence, had much to say about the outlook for healthcare revenue cycle management for the coming year.

In “Medical Billing, Patient Access Top Revenue Cycle Risks of 2019,” Jacqueline LaPointe summarizes the findings outlined in a new report from the public accounting, consulting, and technology firm Crowe, based on 250 risk reports the firm conducted for “hospitals, physician practices, and other provider organizations.” She adds, “New trends and requirements in healthcare are putting medical billing and patient access on the top of the healthcare revenue cycle risk list…” for the coming year.

Top Revenue Cycle Risks

Some of the top risks for healthcare listed in the article include:

  • Medical Billing – Completeness and Accuracy of Billing, Lost Revenue, and Inadequate Denials Management. LaPointe shares that “Crowe researchers observed a significant risk related to incomplete and inaccurate billing, which resulted in costly reworking of claims, increased claim denials, and lost reimbursement.”
  • Patient Access – Pre-Registration/Registration Completeness and Accuracy, Increased Prior Authorization Requirements, Insurance Verification/Eligibility, and Upfront Collections. According to LaPointe, the report suggests that “Controls over patient access functions such as patient scheduling, registration, and admission processes must be rigorous to minimize the risk of billing and patient accounting issues, lost revenue, and poor patient and physician satisfaction.”
  • Charge Capture – Accuracy and completeness of charges. LaPointe advises that “Provider organizations should particularly be aware of the accuracy and completeness of their charges in 2019, especially as they implement new technologies and where high-cost procedures and services are involved.” 
  • Coding – Complexity of codes and provider documentation requirements. On this subject, “researchers advised providers to pay attention to the growing complexity of coding requirements from payers. Providers should ensure adequate physician documentation, and, if coding is outsourced, ensure regular monitoring of third-party vendor performance.”
  • Denials Management – An interdisciplinary approach is necessary. LaPoint’s expert opinion is that organizations “should be taking an interdisciplinary approach to denials management to smooth the claims submission process throughout each department involved.”

The Importance of Preparation

According to LaPointe, the lack of preparation for risks potentially can cost an organization both money and its reputation. She cites the significant fact that “a 2017 survey indicated patient financial responsibility to the provider organization increased 11%. Not only does this indicate that patients are increasingly more aware of how and where they spend their healthcare dollars. It affirms the advanced degree to which patients have become consumers.

She concludes by saying “early identification is the best strategy to mitigate risks” and warns “outsourcing comes with a price. Organizations still need to manage their vendors’ performance.”

nThrive Education is an Effective Solution

A well trained staff and the ability to assess their risks allows the healthcare organizations to prepare for these risks in 2019. HealthStream is proud to offer training from our partner, nThrive Education, for all positions of the healthcare Revenue Cycle, nThrive provides the tools that revenue cycle managers need to assess their staffs knowledge, remediate areas of weakness, and increase their awareness and professional development to all revenue cycle topics.