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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.

denied low-value claims

The High Cost of Not Resubmitting Denied Low-value Claims

Most billers would rather work on fresh claims than to go back and forth with payers to settle denied or partially-paid claims – especially if the new claims are for high-value services. This makes it easy to ignore denied low-value claims as more new claims need to be created and sent out.

But, it doesn’t make sense to let low-value claims go unpaid! At the end of the day, you should be collecting for every single service rendered. If money is slipping through the cracks, it’s time to crack down on your claims management efficiency – and part of this means putting a stronger emphasis on resubmitting low-value denied claims.

Not sure this will make a difference for your organization? Here are the three biggest costs of not resubmitting denied low-value claims.

1. Less income

Every claim that goes unpaid is money you’ve worked for but haven’t received, and won’t receive until each claim is submitted and accepted. It may not seem like much to let $100 or $50 go here or there, but over time, these costs add up. They may result in thousands of unpaid dollars every year, a cycle that will repeat itself until all your claims are accounted for.

Simply by ensuring all denied and partially-paid claims are resubmitted and paid out, you increase your overall revenue.

2. Poor A/R performance

In addition to the financial burden caused by not resubmitting low-value claims, performance indicators take a hit. Collection rates dip as denial rates increase, and these trends will continue until you’ve taken care of your denied claims.

You can also work proactively to solve this problem. Once all denied claims are resubmitted, determine what’s causing so many denials. Make your claims submission process more efficient from the start so that you don’t have to worry about adjusting and resubmitting as many denied claims in the future.

3. Lower patient satisfaction

There’s already enough patient confusion regarding insurance coverage and patient responsibility – and denied unpaid claims only add to patient confusion. They increase frustration, put more responsibility on the patient and may even cause a delay in treatment depending on your organization’s payment policies.

There’s only so much a patient can do to ensure claims get paid. They can provide all the right information at the start of treatment and contact their insurance provider, but it’s your responsibility to manage the claim(s) associated with each patient.

To create a better experience for all, you can:

  • Ask staff to verify patient eligibility and coverage prior to treatment
  • Utilize historical patient data when creating new claims
  • Track claims after they’ve been submitted
  • Resubmit denied claims

Whether you currently have a high or low denial rate, the goal you should aspire to is 0%. Your first step in achieving this is to pay more attention to the denials you’ve been ignoring. Your team and your patients will thank you, and your organization will greatly benefit as a stronger bottom line opens doors to new opportunities.