Q1. How often should a medical practice perform an RCM audit?

Comprehensive RCM audits should be conducted quarterly, with weekly monitoring of key operational metrics such as clean claim rates and AR aging.

Q2. What are the main warning signs of a failing revenue cycle?

Warning signs include AR days exceeding 45 days, denial rates above 8%, uncollected patient balances climbing, and frequent write-offs without management approval.

Q3. How do you identify root causes of chronic claim denials during an audit?

Categorize historical CARC and RARC rejection codes into buckets (eligibility, coding, authorizations, medical necessity) to fix upstream workflow defects.

Q4. What does a Shoreline comprehensive revenue cycle audit include?

Shoreline provides a 360-degree review of front-desk workflows, clinical coding accuracy, clearinghouse edits, payer contracts, and patient collection protocols.

Blog | Efficient Revenue Cycle Management

Executive Key Takeaways

Regulatory Foundation: Learn how to effectively review your revenue cycle process to reduce denials, improve cash flow and maximize reimbursements.
To Learn More, Give Us A Call He: Implementing structured protocols for to learn more, give us a call he directly mitigates documentation discrepancies and streamlines claim submission.
RCM Performance Auditing: Conducting periodic reviews of aging accounts receivable and net collection rates ensures continuous financial health and timely cash flow.
Revenue Cycle Acceleration: Partnering with specialized RCM billing experts eliminates administrative backlog, shortens payment cycles, and safeguards practice revenue.

Table of Contents

1. To learn more, give us a call here
2. Sharanya Rajmohan

Those in the healthcare industry are no strangers to delayed or denied insurance claim payments. Most health systems, hospitals, and physician practices facing this issue risk losing revenue each year. One of the most effective ways to determine how to prevent delayed or denied payments is to evaluate and assess your practice’s revenue cycle. For many healthcare organizations, maximizing the revenue cycle and improving medical billing, medical coding, and accounts receivable are vital for overall growth.

The first question is, “Why do insurance claims get denied in the first place?” Denials are a known issue for any healthcare practice; they delay revenue, add additional work to the billing staff, and create an unpleasant customer experience. The most common cause is missing or incorrect information, such as demographic details, procedural codes, or diagnosis codes. Another reason is prior authorization not being conducted. Other common causes include medical need requirements not being met, procedures not being covered, payer processing errors, the provider being out of network, and more.

A detailed revenue cycle management assessment can help your practice avoid claims denials and ensure you receive regular reimbursement for the services provided. Your revenue cycle assessment should include a review of the following:

Institutional and professional coding and medical billing services:

This review will help identify areas where your practice may be falling short in billing practices, coding accuracy, or claim submission.

Charge capture audit and assessment:

Charge capture audits can help ensure your practice correctly documents services rendered and bills for all procedures performed.

Underpayments, denials, and appeals management:

You can develop a plan to improve claims submission and reimbursement rates by reviewing your underpayments, denials, and appeals management processes. Additionally, a revenue cycle assessment can help you identify and resolve billing discrepancies, ensure billing compliance, and improve cash flow.

Contract management:

This review may include contract reviews to ensure the office is paid correctly and identify recommendations for improving claims management, denial prevention, and Accounts Receivable follow-up.

Reporting and analytics:

Analytics and reporting will give you the data you need to make informed decisions about your revenue cycle management. They should include a review of medical billing revenue cycle, accounts receivable, and denial management reports.

Comprehensive AR management:

A thorough review of the following claims data can help discover areas of improvement and opportunities for cost savings:

• Denial management to maximize claim reimbursement rates.

• The appeals process to appeal denied claims.

• Provider credentialing and Enrollment to ensure providers are appropriately credentialed with payers.

• Medical billing revenue cycle analysis to optimize workflows and increase efficiencies.

• Accounts Receivable (AR) follow-up and collections to maximize reimbursement rates.

Maximize your medical billing, medical coding, and revenue cycle performance with Shoreline Medical Billing company. We help practices address these challenges and improve profitability with services designed to help them maintain focus on patient care. As an extension of you and your team, we have the resources and knowledge you need to help strengthen your business and its profitability without adding more staff and time to your day.