Effective Strategies to Unlock Revenue in Rural Health Care Billing

Did you know? The claims rejection rate frequently reaches dangerous levels when a rural health care clinic, regardless of size, needs to optimize its revenue cycle management. Claim denial has become so common that rural medical organizations have exhausted their resources while failing to generate the promised profit.

Each year, an average rural health care clinic loses 11% of its net revenue owing to underpayments. Claim processing, payments, billing, and revenue cycle management account for 14% of overall rural health care spending or $2.7 trillion in monetary value. There are two main causes for a claim not being paid:

  • The insurer payer does not receive the claim or
  • The claim is insufficient/incorrect.

As a result, today’s rural health care operations provide additional flexibility than they did a decade ago. However, the future will be strong if the right approach and techniques are used.

Here is a quick list of effective strategies to unlock revenue in rural health care billing for 2023:

  • Medical Coding: Do It Correctly to Reduce Denials

Medical coding accuracy is critical to effective Healthcare Revenue Cycle Management in rural health care billing and coding. Proper coding is vital not just for compliance but also for reducing claim rejections and denials and guaranteeing the greatest potential payments for rural health care services.

The following strategies will help you reduce claim rejections and denials:

  1. Avoid using non-specific diagnosis codes. ICD 10 requirements are better and more extensive for the documentation process than ICD 9 standards.
  2. Avoid upcoding–never utilize a higher level of code or more expensive methods compared to the level of service. This will not only cause delays and denials but it is also prohibited.
  3. Avoid under-coding when patients are not charged for all therapy or administrations delivered. Exchanging codes for a lower-cost code is leaving money on the table.
  • Improve Your Revenue Cycle by Organizing a Clear Collections Process

A collection process is required for all rural health care providers to secure their practice’s financial growth. A straightforward and easy-to-understand strategy can considerably increase revenue cycles by ensuring patients are adequately and comprehensively aware of their duties and eliminating a lack of communication.

The following tips will assist you in securely organizing your collection procedure:

  1. Gather all available patient information, including current address, cell number, email address, company data, and so on. Don’t forget to obtain a patient’s photo ID evidence at their initial visit, as this is critical if a bill needs to be forwarded to a collection agency later on.
  2. Understanding effective methods of reaching out to patients is critical. So, you can save time and money by reaching them accurately by checking a patient’s address or contact information regularly.
  3. While speaking with your patients, remind them of their co-pay and why it is necessary.
  • Cash Flow Improvement Through Denial Management

As the rural health care sector evolves, good denial management is one of the most crucial factors in sustaining a sustainable cash flow. Every rural health care provider wants to preserve the clean claim ratio at 97% or above, but specific denials are unavoidable. These denials raise the average amount of days in AR, putting a strain on cash flow.

According to health care research, 50% of denials are never modified, resulting in a 5-7% net loss of potential revenue. Even if you follow the right coding procedures and submit clean claims to lower your denial rate, there will be some denials at the end of the day.

These explored tips will always assist you in effectively managing these denials:

  1. Denials should always be prioritized when completing insurance follow-up and should be handled within 48 hours of receipt.
  2. Make a well-defined list of CARCs (claim adjustment reason codes) and categorize them according to the commonality of subsequent follow-up actions. This makes it easier for users to identify and work on one type of denial at a time, and it allows you to assign a specific type of denial to users who are most equipped to work on them.
  3. Not every denial requires an appeal. Some denials would necessitate a dispute or appeal with the payer. Define your dispute approach explicitly; what is disputable vs. what is accepted?

Outsourcing – The Most Followed Strategy!

Since you are a health care expert, you must thoroughly examine the effective strategies in your rural health care billing to unlock revenue for 2023. Although each rural health care organization is unique and uses its own methods, tools, and operations, you can also use the expertise of a professional rural medical billing service provider who has the knowledge and resources to provide you with the attributes you need to succeed in today’s competitive market.

How about 24/7 Medical Billing Services?

The company has worked with a number of rural health care organizations to help them process claims and make the rural health care billing and coding process as simple as possible. As a customer, you can count on us to complete your billing and coding procedures quickly, efficiently, and precisely.

See also: Interesting Billing Facts Of Rural Health Centres (RHCs)


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