Top Causes of Revenue Leakage in Healthcare
Revenue leakage may be attributed to numerous sources, but identifying the top causes allows healthcare providers to find solutions. According to Effy, a company that leverages big data analysis for healthcare organizations, revenue loss or leakage can be attributed to ten primary causes
- Insufficient registration data entered
- Absence of payor authorization before delivering care
- Ineffective registration of materials used during treatments
- Errors in checking insurance coverage during patient in-take
- Incorrect or inadequate recording of medical procedures
- Billing errors
- Errors in payor-provider agreements
- Pursuing a procedure without insurance coverage
- Payor reimbursement denials
- Delays or mistakes when codifying procedures for claim submission
The good news is that providers can address many of the revenue leakage causes listed above by evaluating their processes, identifying inefficiencies, and targeting improvement. Unverified insurance coverage remains the primary source of claim denials. Coding errors are the primary contributor to Medicare and Medicaid complex claim denials.9 Cleaning up common clerical errors will reduce claim denials based on incorrect insurance and billing information.
Patient Leakage
Healthcare’s broad but incomplete shift from “fee for service” (or a volume-based model) to value-based care requires providers to grow revenues while prioritizing patients’ roles as decision-makers. When patients decide to seek care from providers in other networks or those delivering less value within the network, clinicians lose referral-based revenue and risk losing future income.10
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