3 Revenue Cycle Management Mistakes that Drain Revenue

Healthcare organizations have various metrics that help define and measure success. With so many moving parts, how do you determine what to prioritize?

A strong and efficient revenue cycle is the cornerstone of your organization, so it’s important to start there. It is responsible for paying salaries, buying new equipment and even keeping the lights on.

Are you making the most of your revenue opportunities? Below are three common mistakes that compromise cash flow, and what you can do now to correct them.

  1. Failing to verify eligibility before providing care

Ideally, providers would prefer to verify eligibility for every patient before they receive care. In the real world, this isn’t always possible. Many things can prevent prior authorizations, ranging from unforeseen emergencies to a busy day in the front office that simply doesn’t allow the time.

While you can’t eliminate emergencies, there are ways to cut down on the mountains of paperwork facing your office staff. How many administrative tasks are performed manually? And of those that are electronic, how many different screens do they have to log into to confirm eligibility for just one patient?

Electronic claims management saves a substantial amount of time by enabling batch inquiries and alerts to indicate additional coverage for Medicare beneficiaries. You can verify eligibility for more patients in less time without rejected claims headaches after the fact.

  1. Operating with a fragmented claims management workflow

Speaking of claims, is there anything that requires more time and attention than managing multiple claims with multiple payers? From unique business rules to confusing rejection codes, claims management is usually fraught with long A/R cycles and time lost trying to locate and manage missing claims.

Make your claims submission process more efficient from start to finish with ABILITY EASE® All Payer. With a single platform, you can manage CMS and all other commercial payer claims, verify claims against the most current business rules (as well as customize unique rules for specific payers), and even address eligibility issues up front, prior to claim submission. Most importantly, you can achieve acceptance rates of up to 98 percent.

When rejections do happen, the claim immediately returns to your work queue with a clear message about the correction needed. No more trying to decipher confusing codes while your A/R days pile up.

  1. Writing off denied, low-value claims

In the hustle and bustle of a busy workday, it’s not surprising that low-value, rejected claims become the lowest priority. Billers are stretched thin and their time is better spent working on new, possibly higher-value, claims. But it shouldn’t come down to one or the other. Using the right technology, your staff can successfully handle all types and give a needed boost to a sluggish revenue cycle.

If you don’t find time to settle all of your claims, you aren’t collecting all the revenue you’ve earned. These “low-value” claims add up over time, so what seems like a reasonable write off could result in the loss of thousands of dollars. Not taking the time to resubmit these claims also contributes to poor A/R performance and patient frustration.

Some simple steps you can take to address this issue include:

  • Have staff verify coverage and eligibility prior to treatment
  • Use historical patient data to create new claims
  • Track claims from submittal through payment

The single best thing you can do to strengthen your revenue cycle is to prevent as many rejected claims as possible. This is where electronic claims management systems can have a huge impact.

How to Keep Claims Denials from Affecting Your Revenue Cycle

Claims denials happen throughout the revenue cycle, but often their origins are at the very beginning, the moment a patient seeks treatment.

What’s driving the denials?

According to the Journal of Healthcare Information Management, 86 percent of healthcare industry mistakes are administrative[i]. It’s not surprising when you consider the volume of paperwork faced by front-office staff, and what in many organizations is still a heavily manual workflow.

The Technology CEO Council found that patient charts cannot be found on 30 percent of patient visits[ii]. Without this vital information, basic patient data and benefit eligibility information are missing, leading to claims mistakes and denials.

Unfortunately, eligibility questions aren’t the only problem. In order for claims to be accepted and paid promptly, they must legible, accurate and complete – a tall order considering the number and complexity of diagnostic codes and the pace of regulatory changes.

Denials cost more than you think.

Trying to recover lost revenue can be a lengthy and expensive process, but worth the effort for providers. In the second quarter of 2016, the average automated claim denial from Medicare’s Recovery Audit Program was worth $714. And complex denials that required medical record review averaged $5,418[iii], according to the American Hospital Association.

With so much at stake, preventing mistakes from happening in the first place and avoiding denied claims is the best approach. But how? First, identify the real reason claims are denied:

People make mistakes.

We are human, and sometimes we make mistakes, no matter how good we are at our jobs, or how great we are as people. When you mix our humanity with a very complex healthcare system that is constantly changing — it’s no wonder errors happen. But it doesn’t excuse us from seeking a better way to complete this process.

It’s an easy fix.

Here’s the good news: most revenue lost along the revenue cycle is preventable through automation. And the majority of claims that are denied don’t have to be.

An automated system with a built-in claims scrubber, custom business rules and pre-submission eligibility checks can help ensure the cleanest claims possible. It can also keep up with current diagnostic codes so your staff doesn’t have to.

Imagine having a first-pass acceptance rate of 98 percent. It’s possible with ABILITY EASE® All-Payer, a software application that also helps eliminate the administrative burden of submitting secondary claims.

When it comes to revenue cycle management, it really pays to do it right the first time. Advanced technology makes it possible.

 

[i] Journal of Healthcare Information Management, Volume 17, Number 1, Winter 2003, https://www.himss.org/jhim/archive/volume-17-number-1-2003.

[ii] Technology CEO Council, A Healthy System Report, 2006, http://www.techceocouncil.org/clientuploads/reports/A_Healthy_System_Final.pdf.

[iii] Jacqueline LaPointe, Hospitals Still Facing Medicare Claims Denial Management Issues, October 17, 2016, https://revcycleintelligence.com/news/hospitals-still-facing-medicare-claims-denial-management-issues.

Three Revenue Cycle Management Tips to Simplify Your Medicare Claims

Revenue cycle management should be a priority throughout the patient’s journey — from the moment a patient walks in to receive healthcare services, to the moment that patient pays their final bill. There are many opportunities along this journey for healthcare providers to make their revenue cycle more efficient and productive.

These “big-picture” tools help along the way: clear communication, top-notch staff training, superior organization and state-of-the-art technology. But this high-level, simplistic view of revenue cycle management just scratches the surface when it comes to Medicare claims.

When your revenue cycle management journey includes Medicare, you’ll often experience detours, obstacles, errors, stalls and redirects. (And sometimes you have to do it all over again.)

The job of advanced technology is to make this journey as smooth as possible. Simply put, technology’s main goal is to improve revenue cycle management. This includes such things as: eliminating redundancies, reducing or removing human error, easing frustration and getting that final bill paid quickly and correctly.

What are the best ways to get your Medicare claims to the finish line? Are there ways to save time and money along the way? Here are three tips to help simplify Medicare claims:

Tip #1 Use your time wisely.

It seems like every week there is a new rule or regulation from CMS. Keeping up with these changes is a job in itself. When preparing documentation for Medicare claims, who has time to do anything more than once?

CMS continues to toughen its claims scrutiny, and organizations could see an increase in post-payment reviews. Plus, changing payment models are boosting the number of denials and the need for appeals.

Your time is important. Automate your most time-consuming processes: submission and tracking of ADR responses, RAC audit information and appeals. 

Tip #2 Pass on paper.

These days, stationery stores have all but disappeared, but the healthcare industry still loves (and uses a lot of) paper. Did you know 50 percent of healthcare claims are filed are on paper? This can result in errors and wasted time.

Paper wastes a lot of money, too. A recent CAQH Index® report shows a staggering $8.5 billion is being wasted on medical providers’ manual transactions.

Reduce your overhead and save time by eliminating paper, printing and mailing costs. Instead, submit your Medicare documentation using secure, HIPAA-compliant electronic delivery.

Tip #3 Let technology do the heavy lifting.

Technology plays a critical role in successful claims management. It can streamline your process for secure submission, tracking, and reporting for Medicare claim review programs, and even help ensure proper reimbursement.

Medicare claims offer unique challenges that only the most adaptable, comprehensive and robust application can handle. Applications like ABILITY AUTOMATETM esMD manage Medicare claims and make the process a whole lot simpler for you.

5 Simple, Yet Effective Ways to Decrease Billing Mistakes

Billing mistakes can cost your organization a lot of revenue. From increased days in A/R to claims rejections, you may be surprised at just how much money you’re leaving on the table. Fortunately, though, you can accelerate A/R days, reduce rejections and greatly increase your clean claims rate with just a few simple, yet highly effective strategies.

Always verify patient information and insurance benefits

First, whether you’re handling billing for a patient for the first time or you’ve been treating them for years, you should always verify their information and their insurance benefits up front. A patient may have moved, changed jobs or their benefits may have changed. These changes can easily result in rejections or denials and delay payment.

Significantly reduce billing mistakes by taking the time to double-check patient information and insurance coverage before submitting a claim.

Eliminate repetitive tasks

You may be wondering where you’ll find the time to verify every patient’s information. Fortunately, those verifications don’t have to add extra work when you can put technology to work for you. This next tip will help you save a lot of time while you say goodbye to even more billing mistakes.

With the right application, such as ABILITY EASE® All-Payer, you can eliminate repetitive tasks. For example, this application gives you the power to perform batch eligibility checks and run multiple payers and patients in a single session. So, you can ensure that you’ve verified patients’ benefits information while also significantly decreasing the burden on your billing staff.

Check against the most up-to-date rules

Checking against out-of-date rules will inevitably lead to more claims rejections and denials. Unfortunately, those rules can change on a quarterly, weekly or even daily basis. Your claims management tools should update in real time to ensure that you have visibility into the latest rules. With more clean claims, you’ll see a reduction in billing mistakes and decreased days in A/R.

Address potential eligibility issues up front

If you aren’t sure if a patient — or group of patients — is eligible for certain benefits or coverage, you leave yourself open to claims rejections. Your staff has to deal with the hassle of tracking down those claims and trying to determine what was wrong.

Claims management tools should easily integrate with eligibility verifications to allow you to catch mistakes early, before the claims go out. This saves an enormous amount of time and will likely result in an increased clean claims rate and more revenue coming back to your organization.

Use the right tools for faster correction guidance

When billing mistakes do happen, you can decrease their impact with an application that gives you fast correction guidance. Gone are the days of manually finding the reason for rejections, and then submitting appeals or contacting payers individually. An automated application can route that claim right back to your work queue with a clear message about the corrections needed.

The first step to optimizing your revenue cycle is to correct billing mistakes before they cause revenue problems.

For more tips to streamline your billing processes, visit the billing and claims management page on the ABILITY resource center.

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.

patient satisfaction

The Impact of Patient Satisfaction on Your Revenue Cycle

The value you offer patients has a direct effect on the revenue you collect. This applies to all healthcare organizations, but unfortunately, not all providers understand the impact patient satisfaction can have. The more satisfied your patients are, the better your revenue cycle management performance will be, which affects many other aspects of your business.

Here’s a closer look at how patient satisfaction contributes to financial growth (and losses).

The high costs of low patient satisfaction

Patients want clear pricing and payment expectations. They also want:

  • A deep understanding of their condition
  • Actionable steps they can take to improve their health
  • Simple, stress-free payment processes
  • The option to manage high treatment costs with a payment plan

All these things show patients that they’re genuinely cared for. When providers offer such resources and payment options, patient satisfaction increases. When these aren’t included in treatment, patients are likely to be dissatisfied.

And when satisfaction is low, many aspects of your organization are hindered – including financial performance, market share, and care quality. Dissatisfied patients are less likely to pay their medical bills in full, if at all. There’s very little chance these people return for more services, which is how market share can suffer. Even patients who continue treatment may not be fully engaged, resulting in a decrease in quality care levels as patients stop adhering to their treatment plans.

Luckily, these issues can be avoided by investing more in your patients. There are plenty of ways to increase patient satisfaction while also improving revenue cycle management performance, care quality and much more.

The revenue cycle management benefits of investing more in patients

Providing a more satisfactory patient experience can be as simple as taking the time to explain payment responsibilities or as significant as implementing new tools and processes. Convenient payment technology or an advanced claims management system can help you better serve your patients, your staff and your bottom line.

The following is a closer look at three of the top ways to increase patient satisfaction with improvements to revenue cycle management.

1.     Help patients pay faster – and in full

Price and payments are some of the biggest factors that affect patient satisfaction. While you may not be able to lower your costs, you can make patient payments more accessible and easier to manage with a tool like ABILITY SECUREPAY™.

This allows patients to conveniently pay their fees anywhere, anytime. Patients with ongoing treatment can set up automatic payments and those who see you for one-time services have the choice to pay with a credit or debit card in addition to cash and checks.

These payment practices are very familiar to your patients; they’re tools patients use every day in other aspects of their lives. When patients have the option to pay for medical bills in the same manner, they’re more likely to pay quickly and in full, increasing patient satisfaction and practice revenue.

2.     Decrease billing mistakes

Billing mistakes don’t benefit anyone involved in treatment, yet for most organizations, they’re a common occurrence. These issues slow down your revenue cycle and can lead to lost profits. They’re also a stressor for patients.

If it’s become the norm to see your staff discussing billing mistakes with patients, it’s time to try a new approach. Implement an eligibility and claims management process that creates a satisfactory experience for all. Make it easy for billers to input patient information and track claims. Eliminate the need for your staff to sift through paperwork and the risk that patients’ bills go unpaid by their payers.

This will result in higher patient satisfaction and engagement, a more motivated staff and a healthier revenue cycle.

3.     Prepare for price shopping

One-third of healthcare consumers used the internet or mobile apps during the past year to compare the quality and cost of medical services. They price shopped before seeking treatment, a trend that will continue to rise in the coming years.

Providers need to prepare for this now by improving pricing transparency, strengthening their organization’s brand and increasing patient satisfaction. They need to put a bigger emphasis on value-based care and comprehensive treatment.

These are the details potential patients look for when comparing provider reviews. They keep current patients coming back and new patients coming in to begin treatment. Thinking long-term, an early adjustment to price shopping can mean significant rewards for your organization.

At the end of the day, all the functions of your organization should be rooted in one purpose: serving your patients. If you fail to meet their expectations, revenue performance will be one of the first things to feel the consequences. However, put the above tips to work to make sure your organization is performing well across the board and watch how patient satisfaction skyrockets – and how your entire organization benefits.

revenue cycle management strategy

Why More Utilization of Data Can Lead to Fewer Denied Claims

Denied claims negatively impact your financial performance, put more stress on your billers and hinder the patient experience. However, most denied claims can be prevented!

There’s no reason to let lost earnings continue to slip through the cracks, or to keep settling for delayed payments. With the right tools, you can immediately start improving your revenue cycle management process.

Not sure what your RCM process is missing? Keep reading to discover how using advanced analytics can increase your claims acceptance rates.

Monitor at-risk revenue

Revenue is at-risk of being lost when you have claims that are approaching the 12-month filing limit and when new claims have inaccurate or incomplete patient/payer information.

It’s hard to catch these things when working manually, but an advanced reporting tool can notify you of all the errors you need to fix. It generates the information you need to better prioritize payer responses and provides the visibility to monitor all at-risk revenue. This results in a major workflow shift from constantly playing catch up and fixing errors, to preventing mistakes in the first place, causing fewer denied claims.

Better understand workflow trends and needs

It’s necessary to monitor and work on previously denied claims in the same way it is to submit new claims. More importantly, there’s valuable data to gather from denied claims.

Pull performance reports on all your denials. The data provided should shed light on recurring billing errors and opportunities to better capture revenue. It will help you make sense of why claims aren’t getting accepted and identify workflow issues that need immediate attention. These insights have the potential to improve your clean claims rate, shorten A/R days and boost your bottom line.

Streamline and simplify performance reports

Performance reports are highly beneficial if used properly. Your team needs to focus their time on taking advantage of the key insights within reports, rather than gathering data and creating reports. They need an advanced reporting tool like ABILITY® EASE All-Payer.

When you simplify the creation of reports, you can dig deeper into what the data is telling you. This allows you to quickly start improving your denial rates, rather than wasting time on report generation.

If you’re constantly catching mistakes after a claim has already been denied – or you’re curious why you’ve lost a certain amount of revenue – start reading between the lines. Utilize the data available to you. Apply it to your workflow, share the insights with your team and strive to keep learning. Over time, your acceptance rates will reflect these efforts.

revenue cycle management

How to Reduce A/R Days and Increase Revenue Cycle Management Efficiency

It doesn’t matter how many patients walk through your doors if you’re only receiving a small percentage of payments. You can work hard and provide exceptional care, but as far as your bottom line is concerned, the most important thing to focus on is revenue cycle management efficiency.

What is the average number of A/R days it takes for you to complete a payment cycle? How strong are your claim acceptance rates?

These are just a few of the performance indicators to consider when assessing RCM efficiency. If you’re struggling to receive payments, use the following five tips to bring your A/R days up to speed with the industry average – or even better!

1. Verify eligibility before each visit

It may sound simple enough to verify eligibility before rendering services, yet many billers find themselves jumping through eligibility hurdles after a patient has seen their caretaker.

This may happen because a patient’s coverage has changed from one visit to the next. It could be due to changes in their condition that affect eligibility, or that they didn’t provide all the information necessary for a biller to verify them.

It’s much better to gather all patient information and verify eligibility upfront than to scramble to make a claim post-service. If your current workflow doesn’t stress this, communicate the value of confirming benefits and acquiring appropriate prior authorizations with your front-of-house team immediately.

2. Utilize an automated, rules-based workflow

Think of all the different payers you work with and the many claims you send to them. Consider all the conditions you treat and the unique codes you have to use for each one.

Even your best billers are bound to make mistakes from time to time. They may send a claim to the wrong payer or input the wrong code on a claim to the right payer, resulting in denials and rejections.

The better way for them to work is to utilize an RCM platform with rules-based workflow capability. When you set specific rules, your billers will be notified if they’re about to make a mistake. Your new, advanced system can tell them if information is missing or incorrect. It can advise billers to make necessary corrections before they send out a claim, saving you a significant amount of time in the revenue cycle.

3. Streamline different revenue cycle management processes

It only takes one thing to go wrong for your entire revenue cycle to be affected. And between verifying eligibility, managing claims and processing payments, there are plenty of opportunities for mistakes to occur. Fortunately, you can prevent and correct mistakes by streamlining your RCM processes with a tool like ABILITY EASE® All-Payer.

Stop thinking of eligibility, claims management and payment processing as separate activities. Instead, consolidate these pieces of the revenue cycle into one simple, easy to manage workflow. Invest in one tech-savvy system to help you handle claims from start to finish, instead of having a separate system for eligibility verification, claims and payments.

This will save a significant amount of time, money and stress. It will allow billers to easily move from one step of the revenue cycle to the other. It will lower the risk of mistakes and increase claims acceptance rates.

Before you know it, your average A/R days will be much shorter. Plus, your staff will perform better, become more engaged and have higher overall satisfaction.

4. Diversify patient payment options

With the rise of patient payment responsibility comes a bigger need for providers to diversify their payment options.

Put yourself in the position of a consumer for a moment. Consider how often you swipe a credit/debit card, use a payment application or rely on automated payments to transfer funds. Most people use such tools when paying for everything from a snack at the corner store to their car payment. They expect to have similar payment options when they’re billed for medical services.

This change comes at a low cost when the long-term benefits are factored in. Although it may be a big investment upfront to start offering modern payment options, the positive response from patients will provide the ROI you’re looking for. They are more likely to pay on time and you’ll be able to process payments much easier, too.

5. Resubmit all denied claims

The final way to increase your RCM efficiency is to make sure no claim goes unpaid. The tips mentioned above should significantly reduce the amount of denied claims your team has to resubmit. But, whenever a claim is denied, it needs to be adjusted and sent back to the appropriate payer.

You may prioritize new claims over denied claims. However, every single unpaid dollar adds up – it can contribute to the amount of money you have outstanding, or it can be revenue you collect and utilize.

Luckily, a streamlined workflow can make it much easier to manage denied claims. Combined with a better eligibility verification process, rules-based functions and diversified payment options, your RCM efficiency will be better than ever.

patient education

How to Better Educate Patients About Their Coverage Rights and Payment Responsibilities

Many healthcare consumers experience confusion and stress regarding their insurance coverage and payment responsibilities. They often have questions about when payments are due, how much they’re expected to pay and why their insurance doesn’t cover a certain treatment.

This can deter patients from seeking treatment at all. It can also cause patients to stop treatment before their condition has been resolved, and those who do continue treatment will become disengaged if their confusion and stress aren’t addressed.

Fortunately, all of this can be prevented with better patient education. If you’ve recently had a patient stop treatment due to payment issues or lack of engagement, consider how well you’re explaining treatments – and the associated eligibility requirements and payment responsibilities.

To keep patients informed at the start of and during treatment, use the tips shared below.

Effective patient education methods

Patient education is an ongoing process and a team effort. From front of house staff who schedule appointments and handle patient payments to those who provide patient care, all employees should be dedicated to offering the best patient education possible.

To help your staff do this, consider implementing some of the following patient education strategies:

  • Offer transparent pricing
  • Create flexible payment plans
  • Disclose if a treatment may not be covered by insurance

Additionally, stress the importance of correcting any misinformation a patient may have about their treatment. If their insurance doesn’t cover a procedure that is deemed necessary by their physician, explain the disconnect as well as you can, and discuss other payment options or procedure alternatives.

The connection between patient education and engagement

Patient education and engagement tend to have a direct relationship. When a patient feels well-informed about their eligibility and payment responsibilities, they typically take more ownership in the process and stay up to date with payments.

But when a patient feels like they haven’t been given the proper information, the opposite occurs. They may pay their medical bills, but they may pay late or not in full.

More importantly, the patient experience suffers. While they try to sort out coverages and out-of-pocket expenses, their treatment can be delayed. Their condition could change or worsen, requiring a new treatment plan, and in turn, a change in eligibility, coverage or payments required. If the burden becomes too great, they may find another provider or stop treatment altogether.

claims management

Clean It Up: 3 Tips to Transform Your Claims Efficiency

All healthcare providers want clean claims, but not all billing teams have the right tools and practices to operate efficiently. They may be working manually, taking too long to complete prior authorizations or struggling to keep up with denied claims – all of which can significantly delay the revenue cycle.

If your organization is experiencing any of these billing inefficiencies, it’s time to improve your claims management process. Here are three strategies that will help you and your team work faster and smarter.

1. Streamline eligibility checks

Manual workflows don’t allow for the best utilization of time and talent. Tasks take longer to complete, and the work has a higher chance of error. Automating eligibility verifications can give your team a significant amount of time back in the day. It enables faster claims creation and submission, lowers employee stress and increases patient satisfaction.

Streamlining this process also allows providers to determine eligibility for multiple patients at one time, or one patient’s status with multiple payers. Logging into multiple screens to locate co-pays, termination dates, deductibles and coinsurance information becomes a thing of the past. These electronic systems also store and organize data, making it easy for billers to manage patient eligibility and claims.

2. Improve your denials management process

Denials management can be broken down into two parts: resubmitting denied claims and preventing future denials. Adjusting denied claims should have the same priority as creating new claims, and all claims should be validated before they’re sent and tracked after to ensure they are paid. Validation minimizes the risk of making minor, yet common, mistakes such as:

  • Sending claims with incomplete or inaccurate patient information
  • Sending claims to the wrong payer
  • Submitting duplicate claims

Being more proactive against these issues speeds up your RCM, and sets the tone for ongoing claims efficiency.

3. Simplify patient payments

As patient payment responsibility continues to increase, the need for providers to simplify the payment process will rise as well.

Cash and checks won’t cut it anymore. Patients want to be able to swipe their credit/debit card in your office and submit payments online at their own convenience. Some will prefer payment plans with regular small payments to larger, one-time expenses. Patients may also respond well to automated payment options.

Providing various payment options, combined with automated prior authorizations and improved denials management, ensures claims efficiency across the board. Whether you’re sending a claim to insurance companies, Medicare or directly to patients, each payment process should be simple, stress-free and beneficial for all.