Starting a Medical Practice? Prepare for Billing and RCM Mistakes
Starting a new medical practice is exciting — and terrifying. You can’t prepare for mistakes you don’t know you’re making!
Most doctors don’t learn about billing and revenue cycle management (RCM) in medical school. If you’re launching a new practice, you can protect your financial future by avoiding these common mistakes.
7 Common Mistakes for New Medical Practices Dealing with Billing and RCM
1. Inadequate Insurance Verification
Failing to verify patient eligibility before services are rendered is one of the fastest ways to generate denied claims. Missing or outdated insurance information can delay reimbursement or eliminate it entirely.
2. Weak Front-End Processes
Your revenue cycle starts before a patient is even seen. Incomplete patient intake, inaccurate demographic data and poor documentation create downstream billing issues that are difficult to correct later.
3. Delayed Claim Submission
New practices often struggle with workflow inefficiencies, leading to delays in claim submission. Missing payer deadlines can result in lost revenue that cannot be recovered.
4. Poor Denial Management
Denied claims are inevitable but hit harder when ignored or mishandled. Practices lose revenue without a structured denial management process for appeals and corrections.
5. Lack of KPI Monitoring
Many start-up practices don’t track days in accounts receivable (AR), denial rates or first-pass acceptance rates. Identifying problems or improving performance is nearly impossible without this key performance indicator (KPI) data.
6. Improper Training
Your front office staff may be excellent at patient care and scheduling, but billing requires a specialized skill set. Without proper training, coding errors and inefficiencies can quickly add up.
7. Disconnect Between Clinical and Administrative Teams
Documentation gaps and communication breakdowns occur when providers and billing teams aren’t aligned. This disconnect can lead to undercoding, missed charges and reduced reimbursement.
Can Your Medical Practice Fix These Mistakes?
New practices can take proactive steps to strengthen their revenue cycle:
Implement standardized workflows for patient intake, eligibility verification and claim submission
Train staff regularly on coding updates, payer requirements and compliance standards
Use technology effectively, including practice management software with real-time reporting
Track key KPIs such as AR days, denial rates and collection performance
Establish a denial management process to review, correct and resubmit claims quickly
These steps can improve performance, but they require know-how and ongoing attention. Start-up practices like your own just don’t have the time or resources.
Outsourcing Gives Your Practice a Running Start
Outsourcing your billing and RCM brings:
Specialized expertise in coding, payer requirements and compliance
Efficient workflows that reduce delays and improve first-pass claim acceptance
Proactive denial management to recover revenue and prevent repeat issues
Advanced reporting and analytics to provide full visibility into your financial performance
Scalability, allowing your processes to grow with your practice
Outsourcing allows you to start with proven processes that maximize revenue and minimize risk.
Onpoint — the Best Vendor for Start-Up Medical Practices
Onpoint Medical Solutions acts as an extension of your team. We bring decades of healthcare, operational and billing expertise to your practice from day one.
With Onpoint, you get:
Real-time visibility into your billing and financial performance
Proactive denial management and root-cause analysis
Streamlined workflows that reduce errors and accelerate payments
Ongoing reporting and insights to guide decision-making
A partner who understands the realities of running a medical practice
Build your practice on a strong financial foundation. Partner with Onpoint Medical Solutions and set your revenue cycle up for success from the start.
References
https://www.ama-assn.org/practice-management/cpt/medical-coding-mistakes-could-cost-you
https://www.medicaleconomics.com/view/revenue-cycle-management-avoiding-the-most-common-rcm-mistakes
FAQ
Why is revenue cycle management (RCM) so important for a new practice?
RCM directly impacts your ability to get paid. From patient intake to final payment collection, every step affects cash flow. If your RCM processes are inefficient or inconsistent, your practice may struggle to cover expenses, invest in growth or maintain financial stability.
How do denied claims affect a start-up medical practice?
Denied claims can significantly hurt new practices. Start-ups often lack the resources to follow up effectively. Without a structured denial management process, practices lose revenue that could have been recovered through corrections or appeals.
Can a new medical practice manage billing and RCM in-house?
Yes, but it can be difficult. Managing billing in-house requires trained staff, ongoing education, consistent workflows and time to monitor performance. Many new practices underestimate the complexity, which can lead to costly errors and inefficiencies.
What are the signs that a practice’s billing process isn’t working?
Common warning signs include:
Increasing accounts receivable (AR)
Frequent claim denials
Delayed reimbursements
Staff overwhelmed with billing tasks
Lack of visibility into financial performance
These issues often indicate deeper problems in the revenue cycle.
Why do start-up practices outsource medical billing and RCM?
Outsourcing allows new practices to avoid building complex billing systems from scratch. Vendors provide immediate access to experienced professionals, efficient workflows and advanced technology.