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.

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



How to Improve Your Revenue Cycle Management Process

How well you manage your revenue cycle has a direct effect on your bottom line and the success of your business as a whole. It doesn’t matter how many patients you’re getting in the door if it’s taking months to receive the expected payments for the services you provide.

But, you shouldn’t have to spend hours each day tracking down the payments you’ve worked hard to earn!

There’s a better way to get things done. Here are a few tips on how to make your revenue cycle management operations much easier and more effective.

1.    Implement automated workflows

Think about all the additional success you’d have if you had more time to spend on training your staff, resubmitting low-value claims (which do add up) or treating more patients every day.

You can’t focus on these things as much as you’d like right now because of all the time you’re investing on eligibility verifications and claims processing. With automated workflows, though, the way you spend your time can significantly increase in value while the effectiveness of your revenue cycle management improves.

Instead of going through claims statuses one by one or waiting on standard mail to get a response from payers, you can access the information your revenue cycle needs with just a few clicks of your mouse. You’d be able to access historical patient data and catch mistakes much easier, too. The result? A faster, more accurate way of managing your revenue cycle.

2.    Understand patient preferences

Automating your revenue cycle doesn’t have to end with you. You can also make it easier for patients to submit payments by giving them advanced options – like paying via credit card online or setting up recurring charges.

Your patients are already familiar with online payments. They use tech-savvy payment methods for their home bills, personal subscriptions and even to buy groceries! Giving them the option to pay in the same manner for their healthcare needs isn’t just smart, it’s practically a must.

3.    Keep up with industry changes

In addition to the fact that advanced payment methods make a lot of sense for modern-day patients, having them available reflects your commitment to providing an exceptional patient experience. It goes hand in hand with the rising importance of value-based care.

You have to do more than diagnose a condition or provide successful treatment these days. You need to consider how selective patients are and provide the attention and availability they want as well as the advanced services they need.

It wouldn’t hurt to have an in-house expert to help you keep up with industry changes. This one set of eyes and ears can be dedicated to tracking things like new payment models or stricter infection prevention requirements while you focus your attention on other aspects of your business.

4.    Collect payments up front

Here’s a revenue cycle management tip you can utilize regardless of changes in the industry or the payment methods you provide: start collecting payments before you render services.

This will cause a major shift in how much money is sitting in accounts receivable for an indefinite period of time versus what can be counted as revenue. Even if you choose to only collect partial payment, that’s an improvement.

5.    Don’t let “lost” payments slip through the cracks

While something is better than nothing, ideally, you should be collecting the full payment that every patient/payer owes. At times, this may come down to re-submitting claims and following up with patients more than once.

Some payments simply have to be tracked down. Still, it’s worth spending the time to get what you’ve billed for rather than letting these amounts slip through the cracks. They can either add up as lost costs or as assets – it just depends on how well you stay on top of what’s owed to you.

In fact, one simple thought applies to all these tips: revenue cycle management doesn’t have to be complicated or slow. But, it can’t be improved until you take the action necessary to make it faster and more accurate. Start making the changes your bottom line needs today.