Easy claims management: how a billing consultant keeps it simple

When you think of healthcare claims, “effortless” is not usually the word that comes to mind. Quite the opposite, in fact. But that’s how one billing consultant described her experience using ABILITY’s claims management application.

Regina Burnham is a billing and account management consultant who works with behavioral health providers. To provide the best service to her clients, she needs to manage multiple claims with multiple payers – while maintaining efficiency and accuracy.

Burnham began using ABILITY CHOICE All-Payer Claims to automate her manual claims process. Now, several years later, she still counts on the application to simplify her billing. She explained, “I stayed with it because of the ease of submitting the claims.”

Even Medicare claims don’t slow her down. “ABILITY takes the pain out of getting Medicare claims set up so they can be submitted efficiently,” she said. “And they’re clean claims when they go out.”

Burnham submits her claims with confidence knowing she doesn’t have to choose between speed and accuracy.

View her story to learn more about her experience and how her claims management has transformed for the better.


ABILITY and design®, ABILITY® and ABILITY CHOICE® are trademarks of ABILITY Network, Inc.

How an insurance discovery app drove double-digit increases for a collections agency

How do you improve your collection efforts when you’re faced with limited access to both data and insurance carriers?

Every collection agency has its challenges, but Marie St. James, Chief Operating Officer at Gulf Coast Collection Bureau, was dealing with limited data and delays that significantly impacted collection rates. So, not only did she need to find a way to make improvements, but she also needed to find a partner that could deliver on its promises.

“The biggest challenge with other vendors,” mentioned St. James, “was that they didn’t have the option for bigger carriers such as Blue Cross Blue Shield.”

With the account data the agency received already sitting at 90 to 120 days, timely filing was a constant and critical concern. Combine that with a vendor platform that was not user-friendly, and they found that their collection rate suffered. The organization needed a simple application with improved functionality that didn’t require constant communication with an IT team.

ABILITY Insurance Discovery provided the carrier access and straightforward functionality that strengthened collection efforts across the board.

By switching to ABILITY, the organization can focus more on the collection process instead of simply trying to access data in a readable format. Now, they have improved efficiencies, agents can more easily capture necessary information, and they have increased collections by 10%, according to a recent case study.

Ready to see how this innovative application can help you find more billable coverage? Schedule a demo today to see ABILITY Insurance Discovery in action.

3 benefits you’re missing out on if you’re still using multiple claims management systems

We live in a world where technology seems to connect just about everything. At home, we ask Google to turn on the lights and wake up our kids. On the way to work, we ask Siri to place our favorite drive-through order from Starbucks. Our personal lives are jam-packed with a wide range of sophisticated devices and services that are all connected, each making life a little bit easier.

So, doesn’t it feel strange to sit down to work and have to log on to multiple claims systems or portals, remember several usernames and passwords, and toggle between tabs and screens? Haven’t we moved beyond such cumbersome, outdated, disparate workflows? Truth is, work applications should be as seamless and connected as the apps we use in our personal lives.

Working together to create a powerful, integrated experience, ABILITY EASE All-Payer and ABILITY EASE Medicare deliver the market’s first all-payer system that integrates both government and commercials claims workflows and access. As a single, connected platform, it transforms your revenue cycle management to maximize efficiency, save time and lead to quicker turnarounds for reimbursement.

If you’re still using multiple claims management systems, you are probably missing out on:

1. Single sign-in access to all payers

A single platform integrates clearinghouse functionality, direct payer connections and DDE-scraping technology, allowing providers of any size to manage every claim from every payer, across all locations. That means that employees only need to log in once to submit, edit, track and manage all claims. No more passwords to remember, switching between screens, or wasting time logging in and out of sites.

2. Gold-standard clean claims

The cost of reworking denied claims is often a significant percentage of an organization’s revenue cycle expenses. And, as many as 60% of claim denials are never even corrected and re-submitted for reimbursement!1

With a single platform featuring robust scrubbers with the most up-to-date CMS and commercial payer rulesets, plus facility-specific, customizable rules, organizations can achieve a 99% or greater clean claims rate.2

3. Fast & simple claims resolution

If a claim is rejected by a payer, resolution, resubmission and turnaround times can really hamper time-to-reimbursement.

When billers only need to focus on a single dashboard for all claims management, it’s easy for them to see the claims issues that require immediate attention. Click-to-fix corrections and direct resubmissions (in other words, no Medicare waiting period) ensure that mistakes don’t impact your bottom line.

It’s time to stop jumping between applications and realize the productivity boost and time savings of a one-stop, all-claims platform. Discover how ABILITY’s integrated approach can transform your revenue cycle.


1. “Why getting claims right the first time is cheaper than reworking them,” Timothy Mills, Physician’s Practice, September 9, 2019, https://www.physicianspractice.com/view/why-getting-claims-right-first-time-cheaper-reworking-them

2. ABILITY internal reporting, ABILITY EASE All-Payer, November 2020

ABILITY and design®, ABILITY® and ABILITY EASE® are trademarks of ABILITY Network, Inc.

Three ways to simplify denial management and achieve cleaner claims

It’s no secret that it’s getting harder for healthcare organizations to get paid for their work. As a trusted provider, you are under increasing pressure to collect more money and cut operational expenses while continuing to provide top-notch care, especially during a public health emergency.

On top of that, you are also still faced with keeping your workforce safe and keeping the public protected while in your facility.

The following are three ways to strengthen your overall denial prevention and management process.

1. Analyze denial management and shift your thought process

While you may consider denials a reality of being in healthcare, it doesn’t always have to be that way. Of course, the recent downturn in the economy is causing patients as well as insurance companies to tighten their belts. And that directly impacts your A/R days and cash flow.

This increase in financial pressure is elevated throughout healthcare organizations, which are now forced to be creative and find alternative solutions. The good news is that you have more power than you think to prevent denials. It all begins with understanding reimbursement and compliance rules. This also extends to creating rules within your organization to foster excellent care through optimizing internal denial prevention and management programs.

2. Identify types of denials

Identification and analysis allow you to understand a denial’s root causes. You can then put a process or improvement in place so that the same problem doesn’t reoccur. In other words, it comes down to having a proactive approach to denial prevention.

When you can visualize denials by categories, it helps you create rules for your organization that work towards correcting denial reasons and categories. Once hard or soft denials occur, it can be challenging to get them overturned by the payer. Software from ABILITY helps you identify and understand the rule so that you can consistently follow it and prevent future denials.

3. Optimize your clean claims

Accurate, up-to-date information is a critical part of avoiding denials and achieving clean claims. That means that you need to have solid pre-registration, check-in, and intake processes in place. Preferably, the pre-registration process is happening prior to the patient’s visit.

Denial prevention starts with a clean claim. Be sure to validate all the required information prior to data entry so as many errors as possible are avoided from the start. Keep in mind the types of accurate information needed for an insurance company to process your claim correctly the first time. Doing so will help you improve clean claims and get paid more quickly.

Want to learn more about improving your denial management process?

Check out ABILITY’s free, on-demand webinar, Denial Management Made Easy, where RCM expert Kem Tolliver digs deeper into these important topics. By watching, you’ll get an in-depth look at several key terms and definitions, and common code sets that are integral to the denial prevention process. You’ll also gain access to additional resources to help you avoid claims denials.

ABILITY and design® and ABILITY® are trademarks of ABILITY Network, Inc.

Simplify your claims management

When it comes to claims management, nothing is more exhausting and labor-intensive than jumping between portals to gather information and cross-reference the data you need. Healthcare providers with disparate systems report bigger issues with denials than those using one revenue cycle management solution.1 The ongoing back-and-forth from one vendor platform to another is where manual errors are often introduced, slowing your revenue cycle with denials and additional research. Reports show that having multiple vendors makes it more challenging to identify billing errors or keep up with data variances.2

Plus, if your claims management also involves tools from a vendor whose software lacks integration, you’re probably experiencing fragmentation that can be avoided.

As an ABILITY customer, you know the value of an application that automates your work and adds convenience with a single sign-on for all team members. Imagine replicating that efficiency across your entire claims management process, whether you’re focusing on reimbursement from Medicare or pursuing revenue from private insurers.

How to simplify your processes for better results

Eliminating disjointed platforms not only removes frustration for you and your team, but it also saves money through increased efficiency. With integrated applications for eligibility, claims processing, remits, audits and additional documentation requests (ADRs), you can truly streamline your data and workflow from end to end.

Although integrated software remains a goal for some vendors, ABILITY has a long track record of delivering this technology. Our end-to-end applications work together seamlessly, allowing healthcare providers to easily connect directly with all their payers – from private insurance companies to Medicare – to collect payment quickly and efficiently.

Discover how consolidating to a single platform can help you save labor, accelerate revenue and take control of your processes.


1. HIMSS RCM Survey: Understanding Health Systems’ Revenue Cycle Management and Challenges, Dimensional Insight, May 8, 2018, https://www.dimins.com/white-papers/himss-rcm-survey/

2. “Want to reduce denials? Slim down your RCM solutions” Samantha Meyer, Becker’s Hospital CFO Report, July 12, 2018, https://www.beckershospitalreview.com/finance/want-to-reduce-denials-slim-down-your-rcm-solutions.html#link_tab

ABILITY and design®, ABILITY® and ABILITY EASE® are trademarks of ABILITY Network, Inc.

All claims management isn’t created equal: what you should know

Jarred by a once-in-a-century global pandemic, market volatility and other challenges, 2020 will almost certainly be remembered for widespread uncertainty. Healthcare providers navigating this environment may have the additional burden of outdated or underperforming claims management solutions that contribute to rework and high denial rates.

Unplanned changes can take a heavy toll on organizations struggling to make ends meet, particularly as budgets are strained by increased spending on PPE and other supplies. Faced with so much turmoil, the last thing you need is disruption to your revenue. Adding to the uncertainty is consolidation among software vendors, which may cause disruption and lead many healthcare providers to re-evaluate partnerships.

Is it time to reconsider?

When comparing your current claims management platform to other options, several questions should be top of mind:

  • Is your relationship with your software vendor meeting your needs?
  • Do you have to alter your workflows to accommodate for limited software capability?
  • Are your rejections and denials increasing or improving?

ABILITY’s single sign-on platform trusted for 20 years

As you research the topic, look for technology that enables one stop for smoothly handling claims for Medicare and Medicaid, as well as all private insurers. With ABILITY, your entire team can enjoy single sign-on efficiency and the convenience of integrated applications. Our all-payer claims platform works directly with Medicare to provide real-time data at your fingertips.

You’re not alone with the issues you’re facing. Remember, 2020 has been challenging for healthcare providers of all sizes and in all locations. For two decades, ABILITY has helped organizations like yours simplify administrative complexities through easy-to-use applications and data analytics. Discover how you can save labor, accelerate revenue and take control of your billing with a single platform.


ABILITY and design® and ABILITY® are trademarks of ABILITY Network, Inc.

Insurance discovery: The revenue recovery tool your organization needs

For many healthcare organizations, strong financial performance requires more than clean claims and efficient patient payment processes. A commitment to efficiency, accuracy and ongoing innovation are also essential for a healthy bottom line.

To help capture every dollar earned, many healthcare leaders are adding coverage discovery software to their revenue cycle management toolbox. When executed well, this can lead to better financial outcomes – just one of the many benefits possible with an effective discovery approach.

The following is a closer look at three key results available by implementing a strong coverage determination strategy.

Maximize reimbursements

It’s no secret that having multiple streams of income supports positive financial performance. By better identifying additional billable insurance coverage from third-party payers, providers can create an innovative new way to realize revenue.

To best leverage this channel, it’s worth going beyond the traditional practice of tracking down missed revenue opportunities manually after the point-of-service. Instead, a technology-driven approach can uncover missed insurance on self-pay patients, charity or bad debt in a more simple, effective way.

In fact, providers using ABILITY COMPLETE Coverage Discovery, on average, receive an additional 20% of insurance identification1 to maximize reimbursements. They’re better able to identify additional coverage for Medicaid, Medicare and commercially insured patients, capitalizing on both primary and secondary coverage to most accurately bill for – and receive – payment.

Simplify the intake process

As beneficial as coverage discovery can be for recovering bad debt, it’s also effective for front-end improvements. When staff is better equipped to identify all applicable coverage – primary and secondary, public or commercial – the lifecycle of each claim is likely to be shorter and smoother.

Additionally, the time that would have been spent re-working each inaccurate claim or tracking down the potentially lost revenue afterward, is now saved.

Improve the patient experience

By easing the financial burden on patients, better coverage determination allows healthcare providers to improve the overall care experience.

Identifying coverage helps providers create relief for patients who may be dealing with personal financial challenges. It’s a welcomed addition, considering 14% of Americans live in a household facing challenges with paying healthcare bills2 and an estimated 39% of Americans aren’t able to pay a $400 emergency expense without taking out a loan.3

Take the first step to better results

When viewed holistically, effective insurance discovery is about much more than improving short-term finances. It’s a strategic method to ensure better long-term outcomes across your entire organization, from care delivery to revenue cycle management

To learn how ABILITY COMPLETE Coverage Discovery can help your organization succeed, contact our team at 866.662.0512.


1ABILITY internal reporting; average of customer results.
2 “Problems Paying Medical Bills, 2018,” Amy E. Cha and Robin A. Cohen, National Center for Health Statistics at the Centers
for Disease Control and Prevention, February 2020, https://www.cdc.gov/nchs/data/databriefs/db357-h.pdf
3 “2 ways hospitals can help Covid-19 patients with their bills (without suspending billing),” Rachel Matthews, Advisory Board, March 30, 2020, https://www.advisory.com/research/revenue-cycle-advancement-center/at-the-margins/2020/03/covid-19-billing


ABILITY and design®, ABILITY® are trademarks of ABILITY Network, Inc.

What to look for in a revenue cycle management provider

Regardless of the business you’re in, the capability to efficiently capture, manage and collect revenue is critical to success. Many healthcare organizations are turning to revenue cycle management (RCM) vendors and their high-tech software applications to help them achieve consistent profits. The demand from home health, physician offices and hospitals has resulted in a consistent stream of new RCM companies providing these services. But how do you decide on the RCM platform that’s right for your healthcare operation? Here are the top five things to look for in a revenue cycle management provider.

1. Comprehensive, customizable applications

One of the first things you should look for in a revenue cycle management provider is a full range of RCM components. Depending on your organization’s size, your current staffing and your top priorities, you may need a customized application that is just right for you. A company that offers an “all-or-nothing” approach won’t have the flexibility to meet your specific needs. In addition to all-payer claims and remittance processes, you may need physician scheduling or Medicare eligibility verification at some point. Ideally, you want to choose an RCM vendor who can help you identify your needs and then be equally happy to partner, to consult, to co-manage or to fully outsource their revenue cycle management. Plus, if you start small, you want a provider who can easily add-on the services you need as you grow.

2. Technology and security

Rapid technology changes are common in healthcare. You’ll want to make sure you hire a revenue cycle management provider who offers the most productive and efficient technology, including cloud-based software that’s reliable, easy to use and connects to your existing software. You’ll also want a vendor who stays ahead of changes in technology, modifying their products to bring the best to their customers.

3. Trust and transparency

Your revenue cycle management provider will be critical to your organization’s overall success. That’s why both trust and transparency are so important. Do your homework and read reviews, look at customer testimonials and business case studies. Investigate the company — how long have they been operating? Who are their owners? How involved are they in the industry? What is their financial health?

With regard to revenue cycle management software, will you have full access to manage claims and pull reports? You should have transparency when it comes to knowing and understanding the work that is being performed.

4. Effective software processes

When choosing a revenue cycle management provider, you want to make sure the automated processes implemented by the software are effective and easily customizable to your specific needs. That means your RCM platform needs to support rapid turnaround time for claims, as well as a low percentage of denied claims and a process for resubmitting those claims. Find out what the provider’s denial management strategy is — what percentage of claims are denied in the first place and how many will be resubmitted? You want your RCM vendor to take an active approach to quickly submitting claims and have the processes in place to appeal denials.

5. Personalized customer service — training and reporting

Get to know your potential providers and know the person who will be directly responsible for ensuring the success of your revenue cycle management program. Will that person run, analyze and review reports with you on a regular basis? Are they or other customer service personnel available 24/7? What is their level of expertise in working with healthcare systems like yours?

Part of great customer service includes proper onboarding of the new system with current employees. Make sure your RCM vendor provides onsite training to help you transition to their services.

Discover the difference at ABILITY Network

When searching for the best revenue cycle management provider for your physician practice, hospital or health system, consider ABILITY Network. You’ll find we score at the top of every important criterion you need for a high-quality RCM process. We understand your goal is to maximize revenue and we have the processes and technology to help you do just that. Streamline your workflows, avoiding coding errors and reducing denials means you get paid faster. And when you expedite your cash flow, you’ll have more money in the bank. Improving efficiencies enables your organization to do what you do best — take care of patients. Call 888.895.2649 and let us throw our hat in the ring as your revenue cycle management software provider!


ABILITY and design® and ABILITY® are trademarks of ABILITY Network, Inc.

What is revenue cycle management in healthcare?

Revenue cycle management (RCM) in healthcare is the fiscal process that guides the identification, management and collection of payments for patient services. The process begins with patient pre-registration, is followed by claims submission, and concludes with remittance processing. We understand hospitals, physician practices and other healthcare operations want to prioritize their limited funds to improve facilities for patients and retain caring, skilled staff. Revenue cycle management in healthcare can help you do just that by streamlining and automating the process of receiving timely payments. The objective of RCM is to generate a system that helps you get paid the full amount for the care provided as quickly as possible. Successful implementation of your revenue cycle management is what pays the bills. Learn more about the healthcare revenue cycle and the seven basic steps your RCM process should focus on.

Step 1: Patient pre-registration

Your revenue cycle management process starts when the patient makes his or her appointment. To successfully collect patient payments, healthcare organizations must engage the patient throughout the process. The best way to start is during the first contact with your patient. You’ll establish the patient’s account and collect as much information as possible during this step, including payer information (insurance or other payers such as Medicare/Medicaid), and the medical history you’ll need later in the cycle. Next, you’ll distribute information to the appropriate doctors, nurses and administrative personnel to enable the best possible care.

Step 2: Pre-authorization

In the next step, staff will schedule visits and verify insurance eligibility. Confirming that the service is medically necessary according to the plan’s agreement (assuming it is not a medical emergency) will confirm benefits and help determine payment options. This process can be trying and time-consuming for healthcare staff. Often, organizations employ software that assists in checking patient eligibility electronically, which can expedite the process.

Step 3: Submitting claims

A claim is used by healthcare providers to submit and receive funds from insurance companies or other payers. A “clean claim” that gets reviewed and paid by a payer upon initial receipt expedites reimbursement and improves your cash flow. It’s very important that the physician records information accurately. Without accurately documenting the clinical service provided and attaching the correct code(s), the claim could be denied, or you could receive an incorrect reimbursement. Good software can submit claims electronically, helping to avoid human error.  It’s best if a charge capture system can interface with the electronic medical record (EMR) to optimize identification and capture of charges for more complete billing. You may also want to consider centralized charge standards across all departments to improve consistency. ABILITY Network has several RCM applications to help you streamline your claims management and billing and ensure compliance with CMS guidelines.

Step 4: Posting of the payment

Once you receive the insurance payment and it is posted to the account, you can submit the balance to the patient for payment. Once you have developed a relationship with the patient and gathered contact information, you should be able to use automation tools to send billing statements via mail and/or secure electronic data interchanges (EDI). You could also implement text message reminders. The easier you make it for patients to pay during this step, the faster you will receive payment.

Step 5: Managing and re-submitting denied claims

Tracking your denied claims is an important part of revenue cycle management in healthcare. Claims can be denied for various reasons, such as improper coding, missing items in the patient chart or incomplete patient accounts. Having a process to manage denials can help you recover revenue that might otherwise have remained overlooked because of insurance being filed incorrectly. Properly executed denial management will boost earnings if cash flow has been slow because of problematic claims. You might uncover denial patterns or trends, whether from human error or billing problems for certain types of procedures or members of your patient population. For anything that is not covered by insurance, healthcare organizations must notify and collect payments from the patient. It’s essential that providers help patients understand what they owe and why, identify primary or secondary insurance, consolidate bills, and be able to set up payment plans.

Step 6: Processing payments

Accounts receivable staff should verify all claims payments and process them as quickly as possible. The goal should always be to collect the maximum revenue in the shortest amount of time. You may need account specialists to help identify problem claims and to work with patients on collecting balances due.

Step 7: Financial reports

No automated RCM process is complete without the capability and processes needed to prepare valuable financial reports. Using custom software to develop the financial and management reports you need is key, along with reports on key performance indicators (KPIs) to track whether or not your team is meeting their defined goals.

Let ABILITY simplify your healthcare revenue cycle management

No doubt many medical practices, hospitals and other healthcare providers want to focus more on treating patients than ensuring the financial viability of their company. However, your revenue cycle management process is crucial to running your organization successfully. Without this key financial process, providers cannot keep their doors open to treat patients. That’s where ABILITY can help. We put systems in place to streamline claims management and billing, increase the flow of income, improve the care of your patients and reduce provider costs. Find out how we can help by reaching out via phone at 888.858.0506 or requesting an online quote. We look forward to helping you simplify and optimize your RCM process.

7 revenue cycle management best practices

We understand that your focus is (and should be) caring for your patients. But we also understand that patient care cannot happen without processes in place to ensure proper payment of expenses. With ever-changing healthcare regulations and new reimbursement models, it’s imperative for healthcare organizations to maintain a strong, stable revenue cycle management (RCM) process.

ABILITY Network has developed a variety of applications to help your staff save time and simplify complex tasks. Here are our seven best practices to help you develop and implement a successful RCM program.

1. Collect more information up front

Because the patient is such an increasingly important payer in today’s healthcare system, it’s crucial to collect all personal information available at the time a patient first seeks care — potentially even before they arrive for an appointment. Not only does this information provide the foundation for the claims you will process, but it will also dictate how you will collect payments from the patient or make payment arrangements for the balance due. Effective communication helps patients to understand their benefits and possible treatment alternatives.

2. Aggregate the data

As benefits and insurance regulations continue to change, it’s important to implement a revenue cycle management process that is able to aggregate all of the data throughout the cycle. It will provide benchmarks and analytics for key insights that can improve your process and your business success. Sometimes there is little you can do to increase your income and you may need to look at the expense side of the business. Easy-to-read financial reports can help management and staff to better understand expenses, ways to reduce costs and maximize revenue where possible.

3. Consolidate revenue cycle management to a single provider

Some healthcare organizations use multiple vendors for different revenue cycle functions, requiring extra time and resources to manage it all. Instead, consider consolidating your revenue cycle management operations to a single provider who can provide eligibility verification, claims management and patient payment processing. A single, comprehensive system streamlines workflows, increases staff efficiency and simplifies the billing process for patients, which can help them better understand and meet their obligations.

4. Collect patient payments at or before the point of service

This is one of the most difficult parts of revenue cycle management, but also one of the most critical. Collecting patient payments — as much as you can, as soon as you can — is important in keeping your organization’s money flowing. Determining Medicaid and Medicare eligibility and helping patients understand their coverage options is key. This is made easier by developing a relationship with patients and educating them on the insurance process, so they understand their financial responsibility ahead of time. As medical deductibles increase, more patients are having to pay more and may need to arrange financing or payment options prior to receiving non-emergency services.

5. Track claims throughout their lifecycle

Identifying the reasons for claims denials is as important as resolving them. Verifying insurance eligibility is the first step to ensure accurate billing. It’s also important to be able to track claims from submission to payment. Claims denials from Medicare and other payers should be recorded and analyzed to look for trends or common errors that can be corrected to stop the cycle of lost revenue.

 6. Implement staff development programs

One of the best ways to reduce denied claims is to ensure they are coded and processed correctly. As healthcare changes so quickly, it’s important for providers to develop and implement regular education programs for employees that teach proper coding techniques, comprehensive chart documentation and financial policy reminders. Besides reducing medical errors, training can also help reduce employee turnover.

7. Keep improving performance

 Even if your revenue cycle is functioning nicely, avoid the maintenance-mode mentality. Instead, keep pushing for optimum performance that maximizes your cash flow and net revenue. Use your data to find ways to earn a little more and to save a little more – perhaps by cutting costs, decreasing denials and reducing bad debt and underpayments.

Contact your revenue cycle management experts today

When you need assistance implementing best practices for your revenue cycle management process, reach out to the experts at ABILITY. We have powerful applications to develop and maintain positive revenue cycles within your physician practice, hospital or other healthcare organization — no matter the size. Request your free quote today and start maximizing your revenue.