revenue cycle management

How to Decrease Your Rate of Rejected Claims

Imagine if you went into a patient visit knowing that you wouldn’t receive payment for your work. Would you invest as much time on that patient? Would you hope to see their name on your schedule again?

Compare this scenario with one in which you know for a fact that you’ll receive payment. Most healthcare professionals would choose the latter. However, many hospitals and facilities receive payment rejections on a regular basis. As much as you want to provide every single patient with the best possible treatment, you also need to make sure you’re collecting all the projected revenue associated with your work.

If you’ve been seeing a spike in rejected payments, it’s time to reassess your revenue cycle management efforts. Try using these five tips to help prevent rejected payments.

1. Clean up your documentation and coding process

In a recent HIMSS Media survey, 41 percent of respondents said clinical documentation and coding is a high-risk area for losing revenue, and 43 percent of respondents considered it a medium-risk area.

If you agree, put a stronger emphasis on correct coding. Invest in employee training to ensure that everyone understands the codes your team is working with. Or, try scheduling more people per shift so your team isn’t spread thin and is less likely to make mistakes.

These are just a few ways to improve coding efficiency. If coding errors are affecting your organization, you can’t afford to overlook this issue any longer.

2. Send claims in batches rather than one by one

Sometimes, payment rejections occur because a claim has been submitted to the wrong payer. Additional reasons for rejections include:

  • Inaccurate or missing patient information
  • Inaccurate payer information
  • Terminated coverage
  • Timely filing deadlines
  • No referral on file (for applicable services)

Batches can’t solve all these issues, but they can offset the chances of payment rejections. Working in batches means you can group claims by payer. It reduces the risk of sending claims to the wrong payer and helps you file claims in a timely manner.

Thanks to the digital systems that make working in batches possible, you’re also able to prevent inaccurate or missing patient information as you work through each claim in your batch. Think of your eligibility and claims management system as your second set of eyes. It will tell you if there’s any adjustments you need to make in any claim within a batch. When you have no notifications, you can trust that every claim has all the information it needs to be accepted.

3. Consolidate your claims management

Speaking of eligibility and claims management systems, how many different revenue cycle management tools do you use? Do you have one filing process for Medicare and Medicaid payers, plus a separate way of submitting claims to private payers?

This kind of workflow only increases your risk of rejected payments. On the other hand, using a single portal like ABILITY EASE® All-Payer to communicate with payers makes your RCM more efficient. It increases the accuracy of each claim you make, and helps you catch any mistakes before a claim is submitted.

The result? A faster, cleaner claims management workflow.

4. Track your audits and appeals

Although automated tools can significantly increase claims efficiency, they can’t guarantee first-time acceptances for every single claim. Make sure to track your audits and appeals whenever you find yourself resubmitting claims.

This provides full visibility on all your outstanding payments. It allows you to track financial performance metrics and hold your team accountable to the goals you’ve established. It can also help you adjust your financial strategy if necessary.

5. Save patient data

The final tip to help you decrease rejected payments is to save patient data. This will significantly improve the accuracy of every claim you create, in addition to speeding up eligibility verifications and claims submissions.

Note, this doesn’t mean you should keep storing paper files for all your patients. The better option is to save patient data within your claims management portal. This way, all you have to do to create a new claim is click a few buttons. You can quickly pull the information you need and trust it’s accurate, rather than waste time sifting through piles of paperwork and double-checking everything manually.

There’s no reason to keep letting rejected payments add up, or to spend hours on revenue cycle management. Start using tips above to improve your chances of receiving full payment with a faster, more accurate workflow.

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