5 Tips for Finding Lost Revenue Opportunities in Your Organization

Depending on who you ask, between 10% and 30% of claims are denied, lost, or ignored annually. That’s quite a chunk of change.

Finding lost revenue is essential, as it could be reinvested back into the organization to support the business, which is why it’s critical to work diligently to ensure accurate billing and coding.

Here’s our list of five ways to find lost revenue – and correct the issues going forward.

#1. Ensure Procedure Codes Aren’t Missed

Lost revenue can occur when procedures aren’t documented properly and the provider only uses an E/M code.

For example, if a provider notes that they injected the patient’s left knee with cortisone (without any additional detail like the dosage or the site location, etc.) the codes might only reflect CPT® code 99213 without CPT® code 20610, directly leading to missed revenue.

It’s important to educate providers on why their documentation affects revenue, and what they need to provide documentation-wise to ensure visits and procedures are accurately coded.

#2. Accurately Account for Office Visit Total Time

Providers often think they can only bill for face-to-face time, but there’s a lot of prep work and behind-the-scenes work that often gets missed.

Examples could include:

  • Preparing to see the patient (e.g., review of tests)
  • Obtaining and/or reviewing separately obtained history
  • Performing a medically appropriate examination and/or evaluation
  • Counseling and educating the patient/family/caregiver
  • Ordering medications, tests, or procedures
  • Referring and communicating with other health care professionals (when not separately reported)
  • Documenting clinical information in the electronic or other health record
  • Independently interpreting results (not separately reported) and communicating results to the patient/ family/caregiver
  • Care coordination (not separately reported)

#3. Don’t Forget Behavioral Change Interventions

For patients who have a behavior that is considered an illness (like tobacco addiction, substance abuse, etc.), the most commonly missed codes are those related to tobacco addiction.

Occasionally, there will be a note that smoking cessation was discussed, but the code isn’t included. This should be billed separately from E/M.

These codes include:

  • CPT® code 99406 – Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes
  • CPT® code 99407 – …intensive, greater than 10 minutes, potential topics of discussion could include:
    • Barriers to cessation
    • Relapse triggers
    • Coping issues
    • Risks of use
    • Benefits of stopping
    • Prescription management
    • Support group referrals

#4. Include the Correct CPT® Vaccine Administration Codes

Simple notations do not suffice for vaccine administration. Items that are frequently left off include:

  • Site
  • Route
  • Staff name & credentials
  • Prep
  • Tolerance

If the additional codes are not billed correctly, that also impacts revenue.

  • CPT® code 90461 – Each additional COMPONENT (not per injection)
  • CPT® code 90472 – Each additional VACCINE

#5. Work Smarter, Not Harder

Revenue cycle management starts even before the patient steps in the door. Take a look at processes and procedures to identify possible revenue leaks:

  • Are you billing patients for “no shows?”
  • Are you collecting co-pays at the front desk at the time of the visit?
  • Are your front desk team members empowered to enforce payment policies?
  • You can prepare scripts and offer your team education on this topic to ensure they feel comfortable answering questions and collecting co-pays.
  • Does your entire staff understand the vital role they play in the revenue process?

Find More Revenue Opportunities in Your Organization

Auditors and coders are essential to the revenue cycle in practices, hospitals, and healthcare organizations. In an ever-evolving healthcare landscape, it’s important to continue identifying and educating team members on potential revenue opportunities.


Looking for more expert insights? Check out our webinar on this topic led by Lori Cox from AAPC.


To download this checklist as a pdf, click the button below.

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