7 Steps to Prevent Revenue Leakage in Your Medical Practice

7 Steps to Prevent Revenue Leakage in Your Medical Practice


A revenue leakage in your medical practice is nothing more than the loss of an opportunity to collect your practice’s revenue. Unbilled claims, unbilled procedures, credentialing-related denials, and unpaid patient balances are a few of the reasons for revenue leakage. Because of long payment cycles, medical billing and revenue leakages can result in significant losses for any practice. To maintain financial stability, it is important to monitor the overall medical billing process for loopholes that may prevent a steady cash flow. The purpose of this article is to describe the major issues of revenue leakage and the solutions to them that can help improve your practice’s collections.

Rejected Claims

In most cases, claim rejections are caused by wrong patient demographics and inaccuracy in insurance information. If you do not inform your provider about the change in contact information, or if you change your address, claims could be rejected. The front desk staff must acquire accurate demographic information as well as insurance information while assisting patients with compassion and empathy.

Unbilled Claims

Scrubbing errors can prevent claims from being billed or stuck in medical billing software. Scrubbing features are available in different medical billing software that highlight claims with errors before submission. Scrubbing errors can prevent claims from reaching the clearinghouse and preventing them from being billed. Patients’ appointments, procedures performed, and the number of claims submitted can be compared to identify unbilled claims.

Claims Denial

In the revenue cycle management process, denial management is an essential step that must be handled with the utmost care. A correctly submitted claim is not adequate. Denial management ensures that all submitted claims get paid, and in the event of a denial, an appeal can be submitted with proper documentation. It is best to hire a professional team that can resubmit the claim, identify the causes of denials and devise a corrective process to prevent future denials.

Unbilled Procedures

Physicians sometimes fail to record certain minor procedures in the assumption that they are not billed. Physicians and coders may benefit from having a detailed discussion to identify billed and unbilled procedures. In addition to having a medical coder on your team, who can identify billed and unbilled procedures, you should also have an expert in billing and coding. By educating physicians on billable procedures, unbilled procedures can be reduced and revenue can be increased. An expert medical coder usually helps to identify revenue leakage due to unbilled procedures after having discussion with the physician.

Credentialing Related Denials

Ignorance about provider credentialing can become a source of revenue leakage for any healthcare organization, whether it is a small or large practice. Health plans are sometimes denied coverage because of ignorance about non-participation of certain providers. You need to hire a credentialing company who will be able to handle evolving requirements and regulations regarding provider credentialing and payer enrollment. To run a profitable practice and provide quality patient care, this function is essential.


The majority of physicians are unaware of a fee schedule for various procedures. The same procedure may be paid differently by different payers as per your contract. Fee schedules can be revised to avoid underpayments by planning and reviewing them with the payers. You are not obligated to accept the payer’s fee schedule at the time of contracting; you can negotiate. Get expert assistance in defining your fee schedule and in negotiating with payers.

Outstanding Patient Balances

Ensure maximum reimbursements by establishing a seamless patient balance management process, including timely reminders to patients, electronic payment methods, and flexible payment plans. Verification of the patient’s insurance benefits, co-pays, and deductibles will be the first step in the prior eligibility and benefits process. With a simplified eligibility and benefits process, you can collect more patient responsibility at the time of the patient visit.

To prevent revenue leakage in your practice, Apex MedPro can help you implement the right Revenue Cycle Management Strategies. Find out more about how Apex MedPro can help medical practices and healthcare providers by contacting us at sales@apexmedpro.com or give us a quick Call at 877-333-1760.