Tips to Improve Back-end Revenue Cycle Performance on Your Healthcare Business

| Updated on March 27, 2024

It is not an easy task to run and operate a medical business. Every day, you are responsible for caring for and treating new and sick patients and creating proper billing, and directing your staff to make choices that will benefit your business in the long term.

The following back-end solutions provided by Ventra Health will help you avoid risks and maximize profit margins. Here are some examples of it:

Payment Posting System

Ninety percent of the payment posting process should be automated to reduce human mistakes. Accurate payment posting is essential to overall profitability and ensuring that patients are billed for the right amounts.

The fundamental cause may be found by accurately recording the grounds for rejection. In addition to posting payments, posting charges and denials are all part of the payment posting process. 

Attention to detail is critical since payers may reject an entire claim or just one line item on a claim. As a result, it’s hard to locate a line that was accidentally included in an adjustment or part of the patient’s duty after the adjustment.

Consider secondary and tertiary payers. Most billing systems will electronically submit secondary claims unless revisions the systems. However, if the initial payment is submitted with errors, the secondary claim may be sent to the payer with problems.

Systems for Handling Refunds and Credit Balances

Check credits and refunds periodically to avoid getting unmanageable and distorting performance metrics. Within 60 days, refunds should be clear.

If reimbursements linger for more than two months, you will most likely find yourself dissatisfied and confused customers. There is the potential for confusion and misinterpretation when patients get a credit check from an account they believed had been closed, which may lead to distrust among your patients.

Automated Credit Allocations 

Automation of credit balance applications to other services reduces the time required by personnel for credit balance identification. An automated system may also assist in monitoring regulations for returning/refunding funds for payers and patients.

Electronic Health Records (EHR)

Before the advent of electronic records, medical professionals kept their patient data on paper and kept them in the appropriate files. The patient’s data was undoubtedly organized by this method, but it also has some concerns, such as disclosing private information, the loss of reports, etc. 

The Electronic Health Record (EHR) is a secure and structured way to monitor and gather all of your patient’s health data. ePrescribing, improved patient care, life support and training, and custom snippets to save time are all features of the EHR.

Tips for Dealing with Denials and Appeals

Data should be understood correctly, and rejected claims should be divided between those that may be prevented and those that must be handled when they occur.

A root cause investigation is essential to discover why information is omitted. Track refused claims for missing data.

The rejection may suggest a lack of preauthorization/referral, but digging into the individual payer data may help identify whether your front-end employees failed to secure the data or if the error information was coming from the payer’s mistake.

Priyam Ghosh

Tech and Internet Writer

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