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HEALTHCARE BILLING AUDITS: FINDING LOST REVENUE

Healthcare billing involves numerous steps, people, computer systems, processes, and expertise to make it all work well.  Unfortunately, not all healthcare providers have the expertise or devote the resources that are required to do it properly.  In fact, many healthcare providers withhold resources in order to save on cost.  However, this approach ignores the much bigger cost of missing revenue as a result of inadequate resources, expertise, and processes.  Here at Mhites LLC, we frequently get asked to perform audits of other billing companies and departments.  When we perform these audits, we almost always discover the following:

  • That there has been a lack of thoughtful process design
  • A lack of commitment to following processes
  • A lack of understanding why processes were designed
  • A lack of understanding what the results are, or if results are known, then what they mean
  • A lack of organization (boxes of unprocessed papers and forms, etc)
  • A lack of genuine teamwork, and instead an environment of territorialism and finger-pointing
  • A lack of commitment to using qualified resources in billing and revenue cycle
  • A lack of commitment to customer service
  • A pile of excuses
  • Significant missing revenue

The items listed above are a recipe for disaster, and one that we encounter all too frequently.  Healthcare billing is complicated, insurance companies are constant adversaries to a positive outcome, and the opportunities to systematically miss out on revenue are endless.  When we perform audits of other billing services here at Mhites LLC, the amount of missing revenue we encounter is generally at least 15%, and sometimes up to 50%.  Many healthcare providers ignore this cost and choose the cheapest billing resources, and then lose money consistently.  If you choose a billing process that costs 5% of your revenue, but you’re missing 20% because you aren’t committing the right resources to it, then your billing cost is actually 25% of your revenue.  If you instead commit to a billing process that costs 8% of your revenue, but it results in the consistent pursuit of 100% of your revenue, then your billing cost is only 8% of your revenue.  Would you rather pay 25% of your revenue or just 8%?

The cost of improving billing is small compared to the cost of missing revenue.  All of our clients experience a significant increase in revenue and a consistently high ROI on our services.  We work closely with our clients to design and re-design processes that lead to successful billing.  Each healthcare provider has unique systems and needs, and our approach respects their approach to running their business, while applying the benefit of our billing expertise and hard work.

Our audit process starts with running reports and doing interviews with key personnel.  Based on our preliminary findings, we then customize our approach and dig in to details and processes, including working directly with insurance companies to get to the bottom of things.  Throughout the process, we communicate openly with our client to keep them up to date on findings in order to obtain input and feedback.  In the end, we provide a comprehensive detailed report of all aspects of the business that we audited along with our findings and recommendations.  These audits always provide valuable insight and validation of the reasons that the client wanted the audit done.