Revenue optimization in Q4: How medical practices can lay the foundation for success

If you’re looking to boost medical practice revenue in Q4, you’re not alone. Many practices undertake some form of Q4 revenue optimization. Here are a few reasons why (and how to do it).

• Contract negotiations require up-to-date data. Payer contract negotiations often occur late in the year and having accurate, up-to-date production and payment data strengthens a medical practice’s position for upcoming fee schedule negotiations and revenue optimization.
• It sets the tone for the New Year. A strong financial finish to the year sets medical practices up for revenue optimization in the future.
• Patients want services before the year ends. By Q4, many patients have already met their deductible and are more willing to schedule elective or follow-up care since their out-of-pocket cost is low or zero. In addition, flexible spending accounts and many employer-based plan allowances expire at year’s end.
• Quick wins are easier to identify. By Q4, practices have nine months of actual financial and operational data to compare against goals and benchmarks, allowing them to more easily identify opportunities to tighten denials, boost patient collections, and promote revenue optimization.

Here are five revenue optimization strategies to consider:

1. Ensure accounts receivable are up to date. Review and submit any unbilled claims as soon as possible. This may require an ‘all-hands-on-deck’ approach to address any delays such as lack of physician signatures, coding or modifier issues, or lack of prior authorization. Remember: Every unbilled claim is delayed revenue, and Q4 is your last, best chance to convert it into cash and a cleaner year-end ledger.

2. Buckle down on unpaid patient balances. Unpaid patient balances represent earned revenue sitting idle and cleaning them up before December 31 strengthens both cash flow and your financial metrics going into the New Year. Leveraging front desk and call center staff for empathy-driven collections is critical.

3. Reconcile payments. Did payers pay you everything you deserve? Now is the time to compare payments against fee schedules to appeal any unpaid or underpaid medical claims to promote revenue optimization and give your bottom line a boost.

4. Kick of a patient benefit awareness campaign. Remind patients to use remaining benefits before the year’s end. A targeted campaign can persuade them to schedule now. Medical practices can fill schedules with services patients might otherwise defer (e.g., imaging, therapy, procedures, or checkups). Consider sending text and email reminders for patients to use remaining flexible spending accounts or benefits before they expire. You can also post these messages on the portal and on your website and include them on patient statements. Front desk staff can also remind patients in person and over the phone.

5. Use your data. The fastest way to increase Q4 revenue may be to determine what your own data already tells you about where money is stuck. With nine to 10 months of actual data to identify performance gaps, now is the optimal time for revenue optimization heading into the New Year. Here are several kinds of data that may be most helpful:

• Coding and compliance: Are evaluation and management levels consistent with documentation? Are you missing billable add-on codes for revenue optimization?
• Denials: What denial types increased in Q3–Q4? Which could be overturned before timely filing to promote revenue optimization?
• Payer reimbursement trends: Rank payers by days-to-pay and denial rates. Escalate issues before year-end contract renewals.
• Provider utilization: If one clinician consistently runs 50% capacity, redirect referrals or adjust scheduling templates to ensure revenue optimization in Q4.

Leveraging RCM technology to boost financial performance🔗

Now is also an ideal time to take a close, hard look at RCM technology to determine whether it provides your medical practice with all the benefits and features you need to be successful in the New Year. For example, does offer transparency into the status of your accounts receivable? What about real-time insurance eligibility verification? Does it help you reduce claim denials by pre-screening for billing and coding errors? Learn how Medusind can help with all of this and more for true revenue optimization in your medical practice.