HEALTHCARE BILLING AUDITS: FINDING LOST REVENUE

Healthcare billing involves numerous phases’ viz. people, computer systems, processes, and expertise to achieve the desired result. Regrettably, not all healthcare providers have the expertise or offer the resources that are required for a flawless execution. Ironically, many healthcare providers withhold resources to save on the cost.  However, this approach impacts the cash flows due to inadequate resources, expertise, and processes.  Often we are enquired to perform audits of other billing companies and departments.  While performing the audits, we chanced upon the following deficiencies in:

  • Thoughtful design of the process
  • Commitment to follow the processes
  • Understanding on why the processes are designed
  • Understanding what the results are, or if results are known, then what they mean
  • Improper organizing of the boxes of unprocessed papers and forms, etc.
  • Genuine teamwork, and instead an environment of territorialism and finger-pointing
  • Commitment to using qualified resources in billing and revenue cycle
  • Commitment to customer service and a pile of excuses
  • Significant missing revenue

Very often, healthcare billing is a complicated process as insurance companies are relentless to a positive outcome, and the opportunities to systematically miss out on revenue are endless.  During our internal audit of billing services, it was traced the missing revenue is around 15% which may sometimes may even touch up to 50%.  Keeping a tab on cost vs. revenue is crucial in healthcare billing, as several choose the cheapest billing resources, and lose money consistently rather than choosing a billing process that keeps tab on the cost.  If a billing process is chosen that costs 5% of the revenue but missing 20% due to improper commitment of resources, the resultant billing cost would is actually 25% of your revenue.  Instead if a billing process is committed that may cost 8% of the revenue that yields 100% of the revenue due to a consistent pursuit, the billing cost would actually be 8% of the revenue. It is to analyze wisely to choose between paying 25% of the revenue or just an 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.

As we closely interact with our clients in designing and re-design of processes leading to successful billing  resulting in a significant increase in revenue and a consistent higher ROI in services. We apply the benefit of our expertise years of knowledge in billing to each of our service while respecting their approach in managing their business, systems and needs.

We initiate the audit process by running through the reports and interviews with key personnel.  By analyzing the result, we customize our approach to extract the details and processes, interact with the insurance companies to get to the roots. Throughout the process, we interact with the client to keep them updated on our analysis to obtain input and feedback.  At the end, we provide a comprehensive report encompassing all aspects of the business that we audited. These audits furnish invaluable insights and validation of the reasons that the client wanted, after executing the audit.

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