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.

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,

2. “Want to reduce denials? Slim down your RCM solutions” Samantha Meyer, Becker’s Hospital CFO Report, July 12, 2018,

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

5 hidden remittance problems that are holding you back — and how to fix them

How much are your remittances costing you? You may have hidden inefficiencies draining your time, labor and revenue. If any of the following issues sound familiar, you could benefit from a centralized approach.

  1. Wasted time pulling from different places

How many different sources are you using to pull your remits? If your organization is like most, you probably have to access clearinghouses for some, payer websites or PaySpan for others, and some even come on paper.

Just pulling your remits takes time away from your billing staff that they could use in more productive ways.

  1. Scanning, downloading and printing

Staff often have to scan in remits or save them to downloaded files for research and follow-up later on. These tasks are time-consuming and tedious, and they create a lot of inefficiencies in your billing processes.

  1. Inefficient posting processes

How much time do you devote each week to posting remits? When billing staff are forced to retrieve remits from different places, posting takes more time than it needs to.

  1. Challenges keeping up with multiple tax IDs

If your organization handles multiple National Provider Identifiers (NPIs) and tax IDs, your billing staff may have to split remits to post electronic remittance advices (ERAs) back into different electronic health record (EHR) and electronic medical record (EMR) systems. This is just one more way that disparate systems result in wasted time and increased A/R days.

  1. Cumbersome methods for remit searches

Does your platform let you filter and search remits by different criteria — such as adjustment codes, reason or remark codes? If not, billing staff are forced to get creative and scour through potentially hundreds of remits to find what they need.

A centralized approach to remittance management

How can you take these inefficiencies and challenges out of your remittance management workflows? A centralized approach can save your organization significant time and money.

With the right technology, you could bring back all available ERAs into a single portal, eliminating multiple sources and workflows that your staff have been dealing with.

In one centralized location, you could easily download remittances for autoposting. If your organization handles multiple tax IDs, you could split the remits for posting into different systems. And, you could eliminate all scanning, saving and storing of remits. Instead, you would have a digital filing cabinet for all ERAs for printing and research.

Want to learn more about how you can simplify your revenue cycle with a central source for all your claims management needs? Read about ABILITY EASE® All-Payer here.

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.

advanced payment practices

More Money, Less Hassle: A Closer Look at the Value of Advanced Payment Practices

A high-performing billing office is one that rarely sees denied or rejected claims, makes few mistakes and has a thorough understanding of the payers they work with. It’s one that operates at top efficiency, providing the most possible value to the organization it’s part of.

If your billing office is slow to verify patient eligibility or has a high rate of denied or rejected claims, you’re not getting the most value out of this department. It may be time to introduce advanced payment practices – like the use of EHRs and the implementation of intuitive claims management software.

These can transform your billing performance. They position your team for success by giving them the tech-savvy tools they need to create better, faster results.

Here are the top five benefits of using advanced revenue cycle practices.

1. Enjoy faster claims submission and responses

EHRs allow billers to send claims to payers at the click of a few buttons. Compared to the time it takes to fill out a paper form, prepare it to mail and get a response, the benefit of submitting digital claims is clear. You can shorten your claims submission and response time from a few weeks to a few minutes. This significantly speeds up your revenue cycle, allowing you and your team to keep better track of claims and to see them reflected on the books faster.

2. Send claims in batches

Imagine if your billers were able to fill out and send multiple claims at once rather than managing claims one at a time. The batch claim capacity of some advanced payment tools allows them to do just that. This function gives billers the chance to cut their claims management time in half, if not more. It provides the ability to send a group of claims to each payer your organization works with, then adjust and resubmit individual claims as-needed.

3. Access patient history with ease

A few of the reasons why claims get denied may be:

  • There is missing patient information
  • The patient information provided is inaccurate
  • A claim has been sent to the wrong payer

Being able to generate patient history alleviates these problems. Once billers have all necessary patient information in a claims management system, they can easily retrieve it when creating a new claim without worrying if a patient’s name, address or insurance information is accurate. Billers may have to adjust the date to reflect the most recent visit/treatment or add additional services, but these steps are much easier to accomplish with access to patient history than when starting an entire claim from scratch.

4. Set unique rules

Defining unique rules within a claims management system offers two key benefits: it keeps your team up to date with the latest payer requirements and reminds them of your own facility-specific rules. By making payer rules readily available and/or utilizing if/then functions, you’re giving your billing department the resources they need to work smarter rather than harder.

Billers won’t have to hunt down payer information anymore. They’ll be more in tune with the specific needs of each organization you work with and have a deeper understanding of facility-specific expectations.

5. Reduce A/R days

This is where most organizations see the biggest value in using advanced revenue cycle practices. All the benefits listed above have one combined effect: they can largely reduce average A/R days.

Instead of waiting 60-90 days to see payments on the books, you may be waiting as little as 15-30 days. There’s no guarantee that every claim will be a clean claim or that payers will always provide a fast turnaround, but, when your billing department starts operating at top efficiency, it will put pressure on payers to quickly process claims and send payments. The A/R cycle should speed up and the overall financial performance of your organization will greatly improve.

Additional benefits of using advanced claims management practices include:

  • Fewer claims rejections
  • Fewer human errors throughout the revenue cycle
  • More time back in your team’s workday

Together, these benefits add an immense value to your organization. They create a healthier bottom line, a more engaged team and increase patient satisfaction. With advanced revenue cycle practices, everyone wins.

Billing mistakes

3 Billing Mistakes You Can’t Afford to Make Anymore

It’s hard to grow your business if it takes forever to process claims. The longer you wait for payments to come through, the more you have to put off investing in new initiatives like expanding your team, attending more conferences or moving to a new work space.

You need to address workflow issues and minimize mistakes if you really want to see a change in how quickly you can access payments.

Here are three billing mistakes to stop making right away.

1. Speeding through staff training

It’s hard to know which codes to put on a claim or which payer to send it to if you haven’t been properly trained. Unfortunately, this is the reality many medical billers are dealing with – especially if they’re in entry-level roles.

When billers aren’t shown how to navigate a medical office’s billing software, it’s easy for them to make mistakes. They end up taking more time than average to complete claims and often find themselves re-submitting ones they’ve sent out. The cycle continues until someone steps in to offer better training, but these mistakes can be avoided if new team members are given proper guidance when onboarding.

This is true for long-time billers, too. As new regulations roll out and industry standards change, the people on your billing team are going to look to you for direction. Make sure you’re providing them with all the support they need to succeed. Consider providing quarterly training to cover new initiatives and go over the expectations you’ve set for your staff. Maybe send a few people to conferences and special training opportunities as well.

2. Duplicate billing

It’s worth training physicians and nurses in all parts of the billing process. This encourages better communication across different teams and increases the chances that someone will catch an error before a claim gets sent out. However, it can increase the likelihood of duplicate billing.

Duplicate billing hurts your business in more ways than one. First, it prolongs the billing process and causes confusion for both your staff and patients. Second, you can get fined for duplicate billing if it goes unnoticed by you, but a patient or payer fights the charges. Additionally, you risk losing patients to competitors. If someone has a negative billing experience with you, they’re likely to consider visiting other medical providers who can perform the same services.

Fortunately, you can prevent all these outcomes. The best way to do so is by establishing a clear protocol for how claims will go out. Once you identify the key people whose responsibility it is to send claims, the likelihood of others sending duplicate claims will largely decrease. You can also improve how you track claims as they’re created and when they’re being reviewed by payers.

3. Not verifying patient information – including insurance

This is the simplest billing mistake of all, but it adds up significantly. All it takes is for a patient to forget a signature or not fill in all their insurance information for your billing process to get backed up. It’s also possible that a patient’s insurance information has changed since their last visit. And even when everything looks right, your staff has to verify every single patient form they receive.

Otherwise, you risk running into a pile of denied claims to go back through one by one. This hinders the patient experience and causes a lot of frustration for your staff, too.

Luckily, it only takes one or two extra steps in your billing cycle to keep your staff from starting the eligibility and claims filing process all over. Remind your team to confirm patient insurance before an individual is received for treatment. Set the expectation of photocopying insurance during a patient’s first visit and to verify insurance when making future appointments.

There’s no way to guarantee that absolutely no billing mistakes will affect your revenue cycle. However, there are plenty of opportunities for improvement when you’re able to pinpoint the biggest blockers in your workflow. Take a serious look at your revenue-related operations and identify where you can clean things up, then get to work.

manual tasks

How to Maximize Cash Flow and Minimize Manual Tasks

How much of your team’s workflow involves manual tasks? Are you constantly running into issues like denied claims, scheduling conflicts or coding mistakes on patient forms?

These are just a few of the things that slow down your team. From verifying patient eligibility to coding treatment information to creating schedules and setting company-wide performance indicators, operating manually doesn’t allow much room for growth. It increases the risk of making mistakes and splits your staff’s focus. However, supporting your staff with tech-savvy tools can help them work faster and smarter to create better results.

The following is a closer look at the impact of manual tasks and how switching to an automated workflow can benefit your bottom line.

Understanding the impact of manual tasks

Consider all the manual tasks involved in your revenue cycle alone. If your team creates claims on paper, sends them out via standard mail, then repeats this process when claims are denied, you’re missing out on a substantial amount of money that could be appearing on the books much faster.

When you also consider verifying patient eligibility for every appointment on your schedule, emailing shifts to staff each week and/or processing patient payments by hand, the impact of manual tasks becomes much more apparent.

Manual tasks delay your operations. They increase the likelihood of making mistakes, which then causes staff members to repeat tasks they’ve already done. Working manually also provides little visibility to your organization as a whole; it’s much harder to track things like employee engagement or patient satisfaction if you don’t have the means to gather and make sense of relevant data.

The pitfalls of manual tasks outweigh the benefits. An automated workflow allows your staff to focus on what they do best – whether they’re a biller, nurse, physician or caretaker – while giving you the peace of mind that your organization is operating efficiently.

Moving from manual to automated work

Creating an automated workflow doesn’t happen overnight. There’s a lot of thought that goes into choosing the right systems to implement, as well as identifying which manual tasks you’d like to phase out.

Maybe it’s time to implement a staff scheduling software rather than relying on email to assign and change shifts. Maybe you need to establish a better way to track the rate of patient falls in your nursing home or infection occurrences in your hospital.

You can also explore the option of using a claims management system that can store and retrieve patient history at the click of a button. Or, try sending online claims out in batches versus one by one. Consider how you set and achieve organizational goals, too.

When you’re ready to set automated workflows in motion, focus on getting the most ROI possible. Think of your investment in terms of time as well as money. While your bottom line will benefit from the value of automated systems and tech-savvy tools, you also need to make the most of your staff’s time.

The synergy between the two will create the healthy cash flow you’re looking for. As your staff starts to put their talent into more effective tasks, your patient satisfaction will also increase. These efficiencies will lead to revenue growth both in terms of how much you’re able to bill and how quickly claims hit your books