The Most Effective Way to Deal with Denial Management Claims and Ultimately, Practice Management
Over the last few months, healthcare providers have had to actively pivot to protect patients dealing with COVID-19 while guaranteeing access to services, medicines, and advice for the general population. While many healthcare providers will have focused on providing safe services to patients first and foremost, now is a good time for practices to start reviewing their practice management processes.
The current pandemic is harming the financial positions of many healthcare practices. Like many workplaces, some practices have had to make reductions to their staff to manage their costs. The burden on healthcare providers is currently at an all time high. Revising their revenue cycle management processes allows practices to reduce the impact on their bottom line. One area practices should look at closely to reduce impact on their bottom line is claims denial management.
When it comes to managing the healthcare revenue cycle, the cost of denials can be staggering. On average, denials cost the healthcare system $4.9 million every year. While the volume of patients at larger hospitals exacerbates this cost, even smaller clinics and healthcare providers lose time and money rectifying these claims.
For healthcare providers, managing revenue is a complex process. When errors occur, the result can either be the loss of revenue or a lengthy, complicated process to correct the claim. Denied claims can happen for several reasons, many of which are preventable. These include:
Incorrect or missing data can trigger a denial, as can leaving a required field on a claim form blank. An incorrect member ID, or demographic error, etc. can cause an immediate billing denial. We know how busy front-office staff can be, and human clerical errors can, and often do, happen.
Duplicate Service or Claim
Duplicates are claims resubmitted for a single encounter by the same provider on the same date for the same service.
Not Being Insured by the Payor
If a patient had a procedure that is not covered under their current plan, it could lead to a denial. These can be prevented by verifying the patient’s insurance eligibility before delivering services.
For every provider, claim denials are a disruption to the workflow of their revenue cycle. Thankfully, with the right system, providers can plug any gaps in their claim denials and reduce the impact on their bottom line. With time and resource pressure already making life difficult, providers should consider focusing on outsourcing their claims denial management. This time allows practices to allocate resources where it is most needed; supporting staff and protecting patients.
Working with a revenue cycle management company (RCM) equips providers with a range of claim denial management services including AR follow up, claim status checks, resolution of denied claims, and preparing appeal letters. These services all operate with one goal in mind — to collect all dollars due for your medical services rendered. With policies and payments varying from payer to payer, an RCM can even help prevent denied claims from occurring.
The positive outcomes of outsourcing denial management claims are immense. A holistic management system will reduce gaps in scheduling and allows for a proactive approach to capturing patient data and copays upfront. It also allows for accurate and complete documentation of performed services and the proper coding of those services. Finally, it allows for smooth billing and collections of revenue at the end of the management cycle.
When outsourcing your claims denial management, healthcare providers can expect two things of their cash flow:
- Practices will experience fewer interruptions to their cash flow. With an RCM working around the clock to improve efficiencies, the time it takes to reclaim revenue will be significantly reduced. With less administrative work, front office staff can focus on providing services that directly benefit patients and staff.
- Reimbursements are prompt, giving the practice a more accurate picture of their cash flow. An RCM will take on the role of checking insurance, documentation, and coding for each patient with fewer errors.
There is increasing pressure for healthcare providers to improve the quality of care they are delivering while experiencing losses due to declining reimbursements, higher risk, and tighter margins. An RCM will help your practice improve it’s profit margins while increasing patient satisfaction.
So, how do you know if your practice is ready to make the change towards working with an RCM?
Your practice is struggling to meet revenue goals: Your practice may lack the resources to monitor results adequately or may be falling short on revenue goals due to performance issues. The right revenue cycle management partner will be able to give you specific insights into the areas that can be improved and implement solutions immediately.
Collecting payments is becoming more time-consuming: Many healthcare providers lack the staff and technology needed to collect payments promptly and successfully. If your clinic finds collecting payments from patients more costly, and time-consuming than obtaining payer reimbursements, it might be time to outsource to an RCM.
Gaps in your processes are causing revenue delays: Signs you have gaps in mid-cycle processes can include missing charges, incomplete documentation, and coding errors. An RCM can help identify the key issues and gaps in your processes and recommend solutions for improvement. Tending to these gaps will increase the speed of receiving revenue and reimbursements.
Staff are spending more time on claims denial management: For some providers, the responsibilities of managing denied claims can become overwhelming and conflict with other office duties. Additionally, physicians spend close to 20% or more of their workday on uncompensated tasks, mainly due to regulatory requirements, equating to at least $50,000 of lost revenue annually. Outsourcing to an RCM will free up time for you and your front office staff.
Patients are experiencing frustration with the current system: Healthcare today is a 360 degree, end-to-end patient care experience. 96% of healthcare complaints aren’t related to the quality of care, they’re tied to customer service issues. An RCM can equip your practice with the tools needed to deliver a smoother end-to-end patient experience.
At Health Revenue 360, LLC, we offer leading technology processes with expert assistance that can help your practice flourish through billing, coding, credentialing, and denial management. Whether you want to grow your medical practice or simplify and streamline it, we can help identify and provide solutions to the gaps in your revenue cycle. In light of the current pandemic and to get practices benefiting from these services as quickly as possible, we are offering an accelerated setup and will cover the first three months. Get in touch today to get started.