News and Resources

Top 4 Revenue Cycle Challenges

Dec 18, 2023 | News

This article was published in collaboration with the Pennsylvania Medical Society.  Granite GRC is a proud partner of PAMED, with discounted packages available exclusively for PA Medical Society Members.  Visit https://www.pamedsoc.org/membership/partners to learn more.

In today’s provider practices, common challenges are seen throughout all specialties and revenue streams. Regardless of the number of providers or volume of patients cared for, every private and hospital-based practice is experiencing payer denials, credentialing, contract disputes, and reimbursement negotiations.  Do these challenges sound familiar?

1.      Payer Denials

Denials – when a claim is processed but not paid – is a direct block to revenue.  Denials have seen significant increases in recent years, causing delays to incoming payments, consuming labor hours, and can result in uncompensated care.  Understanding why claims are denied, identifying trends within your organization, and creating a plan to resolve denials can help mitigate the damage to your bottom line.  Of course, the best defense is to prevent denials from happening in the first place.

2.      Credentialing

Credentialing is a tedious, complex process, but can be key to growing your practice.  Creating a credentialing process that is well designed can help you increase your bottom line, remain compliant and improve your overall revenue cycle.

3.      Contract Disputes

It’s common for contracts to be 10+ years old.  Contracts are locked in filing cabinets and forgotten…until it’s time for renewal negotiations.  Rates that were agreed to in the past are not always what is paid in the present, and practices can significant revenues as a result if contract payouts aren’t properly tracked.

4.      Reimbursement Negotiations

Procedures that were high-volume in the past when contracts were first negotiated can naturally evolve into different procedures.  Negotiated rates for services that are no longer provided with regularity are wasted. Revenue cycle managers are heavily focused on the present day – denials, appeals, payer’s submission guidelines, and more.  Staying on top of each contract’s rates can be a challenge.

What are the main pain points you see in your practice?  Granite GRC has a team of skilled consultants that help investigate contract rates embedded in older contracts and negotiate new contracts with updated views into commonly used CPT codes for the practice.  Additionally, having an external team like Granite GRC assess your claims denials and trends from an outside perspective can have a long lasting impact on your bottom line.   The old adage “you can’t see the forest for the trees” carries weight in these scenarios.   It can be challenging to stay productive in your practice, while trying to grow your business.  Allowing an outside view into that forest can produce significant results.  Contact Granite GRC if you’d like to learn more at info@granitegrcconsulting.com, or call (717) 556-1090.

Written by Crystal Stalter, CPC, CCS-P, CDIP, CCDS-O Director, Revenue Cycle Assessment and Compliance.  Granite GRC can help if you need more advice on protecting and improving reimbursement in your practice. Contact us at info@granitegrcconsulting.com, or call (717) 556-1090.