What your revenue cycle team can’t see

Hospital revenue cycle teams are skilled professionals knowledgeable in every aspect of medical billing. It is almost unimaginable that they could be unaware of procedures they could be charging for but aren’t. Yet that is the reality – and for one very good reason. Revenue cycle teams simply lack the skill set necessary to root out missing charges. So here is why your rev cycle team can’t find missed charges.

Revenue cycle process experts

It takes only a glance at job descriptions for the revenue cycle team to see that top priorities are knowledge of medical billing, medical coding, and payer relations. Nowhere in that skill set do you see a knowledge of medical procedures or patient care. Nowhere do you see a requirement for clinical experience.

This might seem self-explanatory – why would you need clinical skills to be effective on the revenue cycle team? And if they are needed, surely that is during the set-up phase of your revenue cycle management and electronic health record platforms.

Yet it is only clinical knowledge that allows someone to look at a procedure and know what aspects are not included in the charges. It is only clinical knowledge that allows someone to look at the different types of care provided and see that they vary widely, despite being lumped under a single level.

Without clinical expertise, revenue cycle teams are unable to see what’s missing in their charges

Supplemental clinical expertise

The remedy to this problem does not require hiring clinicians for your revenue cycle team. As the process of locating missing charges will not need to continue after the charges have been found, there is no need to bring on new staff. A consultant brought in on a temporary basis will be more than adequate to the task.

This consultant needs in-depth clinical knowledge and ideally has a clinical degree. They also need to understand the revenue cycle and medical billing. That combination of expertise will make it possible for them to spot what has been overlooked. 

Immediate and long-term benefits

Once missed charges are spotted, it is easy to submit them to payers and recover the missed revenue. Over the long-term, these missed charges will continue to bring in revenue as they will now be submitted as part of the billing process. 

Recovering missed revenue

Revenue cycle teams that rely solely on knowledge of billing and payers will not be able to find missed charges. However, by supplementing the revenue cycle team with clinical expertise, hospitals can charge accurately and completely into the future. 

Photo by Markus Winkler on Unsplash.

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