Revenue Cycle Management Solutions for Your Medical Practice’s Top Pain Points

By: on December 7, 2017

As a doctor, you probably love helping patients, but hate the paperwork that goes along with the job. That’s why revenue cycle management is many doctors’ (and their staffs’) least favorite part of their jobs.

However, you can’t help patients without obtaining payment, so it’s vital that you are able to get paid by your patients and their insurance providers efficiently.

We wanted to learn more about the greatest frustrations in the revenue cycle, so we partnered with SERMO, the number one global social network for doctors, to survey over six hundred doctors about their revenue cycle pain points.

This article will report on the findings of SERMO’s survey and contextualize doctors’ revenue cycle pain points with actionable advice on how to better manage your health care facilities’ revenue cycle.

Verify Patients’ Insurance Ahead of Time

It’s becoming increasingly common for patients to prepare a variety of paperwork before they come in for an office visit, including their medical history and the reason for their current visit. However, not all practices ask patients for the key piece of information when it comes to the revenue cycle—the patient’s insurance provider and coverage.

According to SERMO’s respondents, one in five doctors does not verify their patients’ insurance prior to that patient coming in for an office visit, which makes revenue cycle management much more difficult.

Making sure you have that information processed and verified before patients come in will help you better manage the entire cycle and nip problems in the bud before the patient ever steps through your door.

Key Takeaway: At the time that a patient schedules their appointment, get all of their insurance information in advance so that you or your staff can verify that insurance prior to the patient’s arrival.

Collect Co-Pays in Person

The entire goal of revenue cycle management is to obtain proper payment for your services. Though much of that payment will come from insurance companies, most patients will also owe a co-payment at the time of their visit, which (to avoid problems obtaining that payment) needs to be collected from the patient, in person.

It’s no surprise, then, that when SERMO asked our doctors about their preferred method of collecting payment, once again we received a pretty decisive answer—80 percent collect co-pays from the patient in person.

Preferred Method of Collecting Co-Pays

Most collect co-pays before appointments while some collect afterwards, but taken together, five out of six doctors make sure they collect patient co-pays in person. Additionally, 11 percent of respondents stated they had no preference, and may be frequently collecting payments in person as well.

Follow-ups to collect payment were extremely unpopular amongst SERMO’s respondents, with 5 percent preferring to follow up for payment via mail and only 2 percent each following up via the phone or a patient portal. Clearly, it is important for the majority of doctors to collect those co-pays from patients while they’re still in the office.

Key Takeaway: Dealing with insurance claims is difficult enough without also having to hound patients for their co-payments, so be sure to collect those co-pays when the patient is there in your office.

Double Check Patients’ Coverages

Probably the biggest hassle in the revenue cycle is dealing with insurance companies. Even functioning at its best, the medical insurance industry is a complex labyrinth of various rules, regulations, exceptions and so forth.

Because of this, claims that doctors submit to insurance companies are denied with alarming frequency, especially (as SERMO’s survey shows) claims for visits and procedures that the insurance company doesn’t cover.

To learn more about denied claims, SERMO asked their respondents to tell us the most common reason for denial. Though less overwhelmingly decisive than the previous two answers, their responses still told us what the majority of doctors find to be the key pain point here—insurance companies not covering a particular visit or procedure.

Most Common Reason Claims Get Denied

Over half of the doctors surveyed find that lack of coverage is the most common reason for denied claims. Tied to this problem, 19 percent of doctors listed that claims were most commonly denied because of the requirement for a referral or pre-authorization, and 11 percent listed that claims were denied because that particular practice was an out-of-network provider for the patient.

It’s clear, then, that more doctors need to not only verify their patients’ insurance ahead of an office visit—they also need to double check that patient’s particular coverages.

Insurance coverages can vary immensely within companies, even within the same plan or package, so it’s important to take the time and effort to verify those coverages beforehand rather than have claims denied.

Key Takeaway: Don’t just check that your patients have insurance before their visit. Look into the details of their particular plans’ coverages so you can alert them ahead of time whether or not that visit will actually be covered by their insurance company.

Use Software to Help You Collect Payments

Our final question for the doctors SERMO surveyed was also in some ways our broadest question—we asked them what the single most difficult part of the revenue cycle is for them.

Though this was the only question for which we received an answer with no clear majority, the top two biggest difficulties both relate to collecting payments, and combined they equal about half of respondents’ biggest pain point.

Most Difficult Part of the Revenue Cycle

24 percent of the doctors we asked find that the most difficult part of the revenue cycle is collecting payments from insurance companies, while 23 percent find it to be collecting balance payments from patients. Obviously, getting paid is hugely important to every doctor and practice, so this is a difficulty that doctors must overcome in order to stay in business.

As with medical conditions themselves, there’s no magical panacea here that can allow doctors and their staffs to collect payments without any hassle whatsoever. However, revenue cycle management software does come closer than just about any other solution to being that cure-all.

These software systems will help health care facilities keep track of every single patient, visit and claim, monitoring the process from the initial appointment through to collecting the final balance. Such copious records will make it much easier to keep on top of overdue payments from patients and help you and your staff navigate through the complexities of obtaining payments from insurance companies.

Takeaway: Take time to research revenue cycle management systems in order to find one that is affordable and useful for your practice, since a more efficient revenue cycle will ultimately net you far more money in payments than the software itself might cost.

Looking Forward

Clearly, revenue cycle management can be an onerous task for doctors, but fortunately revenue cycle management software can help you with this process.

In fact, the software can be helpful to each of the pain points discussed in our previous questions. Software will:

  • Prompt staff to obtain and verify patient insurance at the time an appointment is made (or will ask for this information from the patient directly if they’re scheduling online)
  • Keep track of a patient’s co-payments and make sure they’re paid at the time of a visit
  • Not only verify the patient’s particular coverages, but also eliminate claims that are denied due to human error (i.e., transcription/data entry mistakes or mistaken insurance company addresses)

Here are some steps you can take to figure out what specific software system you’ll want to purchase for your practice:

  • Email me at for more information. I’m happy to help you figure out what your own revenue cycle software needs might be and to connect you to one of our expert software advisors for a free, no-obligation consultation!

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